Pour the coffee: microsurgeons’ beliefs towards caffeine usage after free flap surgery

Background: Microsurgical free tissue transfer (FTT) remains a cornerstone of complex reconstructive surgery, though flap ischemia continues to pose a concern. Traditionally, intraoperative vasopressors and postoperative caffeine have been discouraged due to fears of vasospasm and ischemia, despite conflicting evidence regarding their safety. This study aimed to assess current microsurgeons’ beliefs and counseling practices regarding caffeine consumption after FTT. Methods: A cross-sectional survey approved by the Washington University School of Medicine Institutional Review Board (IRB #202310154) was distributed to 95 attending microsurgeons in Plastic and Reconstructive Surgery, Otolaryngology, and Orthopaedic Surgery across the United States. Responses were analyzed for trends using descriptive statistics, with group comparisons performed via Kruskal–Wallis and Fisher’s exact tests. Results: Thirty-four surgeons responded (36% response rate), of whom 88% practiced plastic surgery with a median of 7 years of microsurgical experience. Over half (56%) did not counsel patients to avoid caffeine after surgery. 21% believed caffeine contributed to flap compromise, 53% believed it did not, and the remainder were unsure or reported variable effects. No significant correlations were found between surgeons’ attitudes and years of experience, annual flap volume, or personal caffeine consumption. Conclusions: Surgeons’ attitudes toward postoperative caffeine use after FTT are heterogeneous, with most not perceiving caffeine as detrimental to flap outcomes. These findings suggest caffeine avoidance is not a universal surgical practice. Further prospective studies and randomized controlled trials are warranted to establish evidence-based guidelines for caffeine use following FTT, particularly in the pediatric population. Level of Evidence: not gradable.