Hangovers affect surgeon's performance

By Dr. Ananya Mandal, MDApr 19 2011

A new study has shown that excessive alcohol consumption, even on the previous day, appears to be associated with changes in some surgical skills performed on virtual reality simulator testing the following day. The study appeared in the April issue of Archives of Surgery, one of the JAMA/Archives journals.

Authors write, “while surgical performance is certain to be impaired acutely with excessive alcohol consumption, there is little information that defines the persistence of this effect. The potential for both early and late alcohol-related performance problems to emerge during laparoscopic surgery is of particular concern given the intense demands it makes on cognitive, perceptual and visuospatial abilities and the known vulnerability of these human factors to the effects of alcohol”

For the study researcher Anthony G. Gallagher of the National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, and colleagues examined the effects of previous-day alcohol consumption on laparoscopic surgical performance using naturalistic, true-life setting. Sixteen male final-year science students at Queen's University were included in study one and eight laparoscopic experts participated in study two. All participants were trained on the Minimally Invasive Surgical Trainer Virtual Reality (MIST-VR) and baseline scores were recorded on day one.

The students were divided into groups. Eight students were randomly assigned to the alcohol consumption group, and the other eight were randomized to the control group. Students in the alcohol consumption group participated in a group dinner, and were asked to consume alcohol freely. Students in the control group also participated in a group dinner, but no alcohol was served. One or more of the investigators was present for all events, and observed signs of intoxication in both alcohol consumption groups. The participants performed tests of simulated surgical skill performance on the MIST-VR the next day at 9:00 a.m., 1:00 p.m. and 4:00 p.m.

Results showed that the control group showed no changes in performance factors from the baseline test through the three test sessions in all three areas tested. The areas tested were –

• Time
• Errors and
• Economy of diathermy (ability to perform technique designed to produce local application of heat).

Students in the alcohol consumption group, however, performed worse on all three measures and showed considerable performance variability. Although differences were seen in the time it took participants to perform the tasks, only the difference at 9:00 a.m. was statistically significant.

For the second part of the study the experts made more errors at 9:00 a.m., 1:00 p.m. and 4:00 p.m., compared with baseline assessments, however only the difference at 1:00 p.m. was statistically significant. The experts performed the tasks faster at 9:00 a.m. when compared with baseline results, however performance was significantly worse during the 1:00 p.m. tests. Performance had returned to baseline levels by 4:00 p.m.

Authors concluded, “In the two studies reported herein, we showed persistent detrimental performance effects the day after excessive alcohol had been consumed. Given the considerable cognitive, perceptual, visuospatial and psychomotor challenges posed by modern image-guided surgical techniques, abstinence from alcohol the night before operating may be a sensible consideration for practicing surgeons.”

A 1993 study had showed that 42% of healthcare workers acknowledged having a hangover at work. And among doctors, surgeons are known to have a particular fondness for drinking, according to some other studies and the casual observations of many physicians. Unlike airline pilots, who have had to follow a “bottle-to-throttle” mandate restricting drinking before flights since 1971, surgeons have no “bottle-to-scalpel” rule. No airline pilots can fly if they have consumed alcohol 8 hours before takeoff or if their blood alcohol is 0.04 or more, according to federal regulations, and pilots are encouraged not to drink at all the day before flying.

Dr. Gallagher said, “Surgeons and other [medical personnel] should not drink excessively the night before operating. The definition of excessively is an issue that needs to be defined by the surgical profession.”

Dr. Albert Wu, professor of health policy and management at Johns Hopkins University Bloomberg School of Public Health in Baltimore said that in medical profession “doctors are expected to be substance-free all the time on the job, but there's no real rule of [drinking alcohol outside of work hours].” He added that, “If their findings are replicated, it would reasonable to [restrict] alcohol consumption 'x' hours before assuming duty.” Wu warned, “This is just the tip of a substantial iceberg… Almost everyone is impaired at some point in time. It's plausible to think a splitting headache or sleep deprivation would affect attention and conscientiousness, even skipping meals, fighting with a spouse, looming debt, a sick family member.” He suggested future research in this area.