title: The effect of alcohol on surgical skills.
abstract: BACKGROUND
  The General Medical Council states 'a surgeon must not work when their health state is adversely influenced by fatigue, disease, drugs or alcohol'. However, there are no defined criteria for acceptable blood alcohol levels when operating. The aim of this study was  to measure the effect of varying amounts of alcohol on surgical dexterity, cognitive abilities and the social interactions required to ensure patient safety during a routine ear, nose and throat (ENT) operation.
  
  
  METHODS
  ENT surgeons were asked to perform a microlaryngoscopy with  excision of a predetermined glottic lesion on a validated laryngeal model. The procedure was repeated four times over a period of four hours with varying doses of alcohol (no alcohol control, one glass, three glasses and six glasses of wine). The parameters recorded included theatre etiquette,  surgical time, operative skills and patient safety. Scores were adjudicated by two independent observers.
  
  
  RESULTS
  The more glasses of wine consumed, the more detrimental the effect was on the surgical performance of all participants. There was a global reduction in ability of 7.25%  after three glasses and 19.25% after six glasses of alcohol. No domain showed an improvement following sequential increase in blood alcohol concentration.
  
  
  CONCLUSIONS
  This study suggests that there are no deleterious effects on surgical performance following the consumption of one  glass of wine 45 minutes prior to microlaryngoscopy among ENT surgeons of varying experience. However, there is clear evidence that with three or more glasses of wine there is an adverse effect on performance, with decreased surgical dexterity, cognition functions and professionalism.
authors.affiliation: Brighton and Sussex Medical School, UK.
authors.forename: G
authors.initials: G
authors.lastname: Kirby
authors.forename: K
authors.initials: K
authors.lastname: Kapoor
authors.forename: P
authors.initials: P
authors.lastname: Das-Purkayastha
authors.forename: M
authors.initials: M
authors.lastname: Harries
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D002983:Clinical Competence / Q000592:standards*; D005246:Feedback; D006801:Humans; D007400:Interprofessional Relations; D007828:Laryngoscopy / Q000592:standards; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D009048:Motor Skills / Q000187:drug effects*; D010036:Otolaryngology / Q000592:standards*; D011364:Professional Practice / Q000592:standards*