Association of Weight-Adjusted Caffeine and β-Blocker Use With Ophthalmology Fellow Performance During Simulated Vitreoretinal Microsurgery

Abstract

IMPORTANCE Vitreoretinal surgery can be technically challenging and is limited by physiologic characteristics of the surgeon. Factors that improve accuracy and precision of the vitreoretinal surgeon are invaluable to surgical performance.OBJECTIVES To establish weight-adjusted cutoffs for caffeine and β-blocker (propranolol) intake and to determine their interactions in association with the performance of novice vitreoretinal microsurgeons. DESIGN, SETTINGS, AND PARTICIPANTSThis single-blind cross-sectional study of 15 vitreoretinal surgeons who had less than 2 years of surgical experience was conducted from September 19, 2018, to September 25, 2019, at a dry-laboratory setting. Five simulations were performed daily for 2 days. On day 1, performance was assessed after sequential exposure to placebo, low-dose caffeine (2.5 mg/kg), high-dose caffeine (5.0 mg/kg), and high-dose propranolol (0.6 mg/kg). On day 2, performance was assessed after sequential exposure to placebo, low-dose propranolol (0.2 mg/kg), high-dose propranolol (0.6 mg/kg), and high-dose caffeine (5.0 mg/kg).INTERVENTIONS Surgical simulation tasks were repeated 30 minutes after masked ingestion of placebo, caffeine, or propranolol pills during the 2 days.MAIN OUTCOMES AND MEASURES An Eyesi surgical simulator was used to assess surgical performance, which included surgical score (range, 0 [worst] to 700 [best]), task completion time, intraocular trajectory, and tremor rate (range, 0 [worst] to 100 [best]). The nonparametric Friedman test followed by Dunn-Bonferroni post hoc test was applied for multiple comparisons. RESULTSOf 15 vitreoretinal surgeons, 9 (60%) were male, with a mean (SD) age of 29.6 (1.4) years and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 23.15 (2.9). Compared with low-dose propranolol, low-dose caffeine was associated with a worse total surgical score (557.0 vs 617.

Coffee break has no impact on laparoscopic skills: a randomized double-blinded placebo-controlled parallel-group trial

“…The influence of caffeine intake on operative skills has been the subject of some studies. However, these were mainly done in ophthalmology [15][16][17][18][19], or with very small participant numbers between 5 and 22 participants [8,[15][16][17][18], or they were restricted to novice fellows or students [8,18,19].…”

“…In some previous studies it is not mentioned if participants had abstained from coffee before the study [ 16 , 18 ]. We included subjects who had drunk coffee before which is consistent with another study [ 19 ]. The rationale was that we wanted to ensure a normal setting as most surgeons will have their morning coffee some time before surgery and will additionally drink coffee directly before an operation or between two operations.…”

“…Complete caffeine abstinence might lead to an improvement according to some studies [ 18 , 19 ]; however, such a proposal is not close to reality as many surgeons consume caffeine regularly. In a large study which surveyed 951 surgeons working in hospitals, lifetime, past-year, and past-month prevalence for caffeine drinks were about two thirds [ 7 ].…”

“…Tremor as a consequence of coffee consumption and its effect on surgery performance have not been widely studied. Studies have been performed especially in ophthalmologists and while some studies found that surgeon hand tremor is not influenced by caffeine [15][16][17], others advise against the use of coffee before surgery [18,19].…”

A Multifactorial Approach for Improving the Surgical Performance of Novice Vitreoretinal Surgeons

“…5 The methods were sufficiently sensitive to detect significant dose-dependent differences in surgeon's performance. 5 The current study applies these methods to multiple surgeon variables that were previously unstudied, potentially significant, and modifiable.…”