COMMENTARY

Preoperative Smoking Cessation: Does It Work? Is It Practical?

Alex Macario, MD, MBA

Disclosures

October 18, 2013

The Effectiveness of a Perioperative Smoking Cessation Program: A Randomized Clinical Trial

Lee SM, Landry J, Jones PM, Buhrmann O, Morley-Forster P
Anesth Analg. 2013;117:605-613

Study Summary

Sometimes one reads an article that rings true as being something that every anesthesia group should aim to do.

Being scheduled for surgery may be a "teachable moment" for patients in that the concern about the operation may make them more receptive to medical advice and treatment than at any other time. Although anesthesia groups could have a system in place to take advantage of this by offering a preoperative smoking cessation program, few practices do so.

Approximately 19% of US adults smoke, which increases the risk for complications after surgery, in particular adverse respiratory function and poor wound healing. This randomized controlled trial showed that a smoking cessation intervention offered in the preadmission clinic 3 weeks before surgery increased smoking abstinence rates. At 1 month after surgery, 29% of the intervention group reported not having smoked in the previous 7 days compared with 11% of the control group, which did not receive any specific smoking cessation instruction (relative risk, 2.6; P = .008).

The smoking cessation program offered by the Department of Anesthesia at St. Joseph's Hospital, an ambulatory and short-stay surgical facility in London, Ontario, Canada, included the following elements:

A 5-minute counseling session by a trained preadmission nurse;

Handing the patient a brochure on smoking cessation from the Canadian Cancer Society;

Referral to the Canadian Cancer Society's Smokers' Helpline (of interest, of the 84 patients in the intervention group, the Smokers' Helpline was able to establish contact with only 52% of patients for free and confidential counseling); and

A free supply of transdermal nicotine replacement therapy. Patients smoking > 10 cigarettes/day received a 4-week supply of 21-mg/day, a 1-week supply of 14-mg/day, and a 1-week supply of 7-mg/day patches. Patients smoking < 10 cigarettes/day were given 4 weeks' worth of 14-mg/day patches and 2 weeks of 7-mg/day patches.

Smoking cessation on the actual day of surgery was confirmed with both a self-report of 7-day abstinence as well as biochemical confirmation with exhaled carbon monoxide. Lee and colleagues found that at the time of surgery, smoking cessation occurred in 14% of patients in the intervention group compared with 4% in the control group (relative risk, 4.0; P = .03).

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