Vitreoretinal surgical performance after acute alcohol consumption and hangover

Marina Roizenblatt; Peter Louis Gehlbach; Vitor Dias Gomes Barrios Marin; Arnaldo Roizenblatt; Thiago Marques Fidalgo; Vinicius Silveira Saraiva; Mauricio Hiroshi Nakanami; Luciana Cruz Noia; Sung Watanabe; Erika Sayuri Yasaki; Renato Magalhães Passos; Octaviano Magalhães Junior; Rodrigo Antonio Brant Fernandes; Francisco Rosa Stefanini; Rafael Caiado; Kim Jiramongkolchai; Michel Eid Farah; Rubens Belfort Junior; Mauricio Maia

doi:10.1136/bjo-2023-324044

Vitreoretinal surgical performance after acute alcohol consumption and hangover

Br J Ophthalmol. 2024 Jul 31:bjo-2023-324044. doi: 10.1136/bjo-2023-324044. Online ahead of print.

Authors

Marina Roizenblatt^{1

2}, Peter Louis Gehlbach², Vitor Dias Gomes Barrios Marin³, Arnaldo Roizenblatt³, Thiago Marques Fidalgo⁴, Vinicius Silveira Saraiva³, Mauricio Hiroshi Nakanami³, Luciana Cruz Noia³, Sung Watanabe³, Erika Sayuri Yasaki³, Renato Magalhães Passos³, Octaviano Magalhães Junior³, Rodrigo Antonio Brant Fernandes⁵, Francisco Rosa Stefanini³, Rafael Caiado³, Kim Jiramongkolchai⁶, Michel Eid Farah³, Rubens Belfort Junior³, Mauricio Maia³

Affiliations

¹ Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil maroizenb@gmail.com.
² Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA.
³ Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.
⁴ Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
⁵ Department of Ophthalmology, USC Keck School of Medicine, Los Angeles, California, USA.
⁶ Kaiser Permanente Medical Center, Mclean, Virginia, USA.

PMID: 39089845
DOI: 10.1136/bjo-2023-324044

Abstract

Aim: Routine alcohol testing of practicing physicians remains controversial since there are no uniform guidelines or legal regulations in the medical field. Our aim was to quantitatively study the acute and next-morning effects of breath alcohol concentration (BAC)-adjusted alcohol intake on overall simulated surgical performance and microtremor among senior vitreoretinal surgeons.

Methods: This prospective cohort study included 11 vitreoretinal surgeons (>10 years practice). Surgical performance was first assessed using the Eyesi surgical simulator following same-day alcohol consumption producing a BAC reading of 0.06%-0.10% (low-dose), followed by 0.11%-0.15% (high-dose). Dexterity was then evaluated after a 'night out' producing a high-dose BAC combined with a night's sleep. Changes in the total score (0-700, worst-best) and tremor (0-100, best-worst) were measured.

Results: Surgeon performance declined after high-dose alcohol compared with low-dose alcohol (-8.60±10.77 vs -1.21±7.71, p=0.04, respectively). The performance during hangover was similar to low-dose alcohol (-1.76±14.47 vs -1.21±7.71, p=1.00, respectively). The performance during hangover tended to be better than after high-dose alcohol (-1.76±14.47 vs -8.60±10.77, p=0.09, respectively). Tremor increased during hangover compared with low-dose alcohol (7.33±21.65 vs -10.31±10.73, p=0.03, respectively). A trend toward greater tremor during hangover occurred compared with high-dose alcohol (7.33±21.65 vs -4.12±17.17, p=0.08, respectively).

Conclusion: Alcohol-related decline in simulated surgical dexterity among senior vitreoretinal surgeons was dose-dependent. Dexterity improved the following morning but remained comparable to after low-dose alcohol ingestion. Tremor increased during hangover compared with same-day intoxication. Further studies are needed to investigate extrapolations of these data to a real surgical environment regarding patient safety and surgeon performance.

Keywords: Pharmacology; Retina; Treatment Surgery.