Perioperative Smoking Abstinence Possible With Counseling

May 14, 2011

May 14, 2011 (Washington, DC) — Urologists should consider providing preoperative smoking cessation counseling to their patients undergoing urologic surgery, researchers urged today here at the American Urological Association (AUA) 2011 Annual Scientific Meeting.

A team from Emory University School of Medicine, in Atlanta, Georgia, tested the use of a brief tobacco cessation protocol — known as Ask, Advise, and Refer — in a small group of self-described cigarette smokers who were scheduled for a broad range of urologic procedures.

The results showed a modest decrease in perioperative smoking.

"While we would have liked to have had better results, we believe that either supplemental or alternative methods may be necessary to improve perioperative smoking cessation rates, " Kenneth Ogan, MD, associate professor of urology, and director of the Stone Center in Atlanta, told Medscape Medical News.

He added: "Given the links between cigarette smoking and multiple urologic cancers and other urologic pathology, we believe that urologists should take a more active role in smoking cessation. Unfortunately, surgeons — urologic and nonurologic — only occasionally ask patients if they smoke, and even more infrequently provide assistance in helping smokers quit."

Patients counseled using the Ask, Advise, and Refer approach are asked if they smoke and are advised to quit smoking prior to surgery and over the long term. They are also given educational materials highlighting the benefits of smoking cessation and are referred to a free smoking cessation hotline.

The study consisted of 41 cigarette smokers scheduled for urologic surgery who reported a smoking history of about 30 years.

On the day of surgery, 10 of 33 patients (30%) maintained that they had quit smoking. However, 3 of the 10 patients (30%) tested positive on the carbon monoxide breath test assessing short-term smoking abstinence, and 5 of the 10 patients (50%) tested positive on the urine cotinine test assessing long-term abstinence.

At the first postoperative visit, 8 of 28 patients (29%) said that they had quit smoking. However, 4 of the 8 patients (50%) tested positive for carbon monoxide and 3 of the 8 (38%) tested positive for urine cotinine.

Even so, postoperatively, 25 of 28 patients (89%) said they still wanted to quit smoking.

No patient used the smoking cessation hotline.

"Surgery puts smokers in contact with the healthcare system, provides a 'teachable' moment, and causes forced abstinence," Dr. Ogan said. "Hopefully, this pilot study will encourage more urologists to enact a smoking cessation program in their practice, with the short-term goal of abstinence prior to surgery and the ultimate goal of long-term abstinence."

"I think that we urologists, given the link between urologic pathology and smoking, need to at least raise the issue of smoking cessation with our patients, although most of us probably don't know specifics, like which smoking-cessation drugs to recommend and which other nondrug methods might be helpful," Anthony Smith, MD, chair of the AUA Public Media Committee and professor and chair of the urology division at the University of New Mexico in Albuquerque, told Medscape Medical News. "General practitioners are probably better suited to counsel patients about those things."

He added that patients often quit smoking "on the spot" upon learning that they have cancer, even if the cancer is not linked to smoking.

"The conversation with the patient goes like this: 'Do you smoke? No, I don't. When did you quit?' At that point, the patient will cite a specific date and hour at which he quit smoking, which is the day on which he was diagnosed with cancer. Cancer is often a wake-up call to patients that they need to quit smoking."

He added that there is "increasing conversation" about urologists playing more of a primary care role in their elderly patients. "A discussion about smoking cessation definitely plays into that conversation," he said.

The study received no outside funding. Dr. Ogan and Dr. Smith  have disclosed no relevant financial relationships.

American Urological Association (AUA) 2011 Annual Scientific Meeting: Abstract 54. Presented on May 14, 2011.