A high-intensity intervention is not needed to accomplish smoking cessation before surgery.  (Image source: Thinkstock)
A high-intensity intervention is not needed to accomplish smoking cessation before surgery. (Image source: Thinkstock)

Preoperative clinics can do more than prepare patients for surgery: they can also teach healthy habits, such as smoking cessation.  In the article “The Effectiveness of a Perioperative Smoking Cessation Program: A Randomized Clinical Trial” published in the current issue of Anesthesia & Analgesia, Dr. Susan M. Lee, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, and colleagues show that such a teaching smoking cessation program can be accomplished with little additional effort.

168 patients who were to undergo ambulatory or inpatient surgery with an expected hospital stay < 3 days, and who were seen at least 3 weeks before surgery, were randomized to either a control group or a smoking intervention group.  The smoking intervention consisted of patients nicotine replacement therapy, a 5 minute intervention by a preadmission nurse, smoking cessation brochures, a referral to the Canadian Cancer Society’s Smokers’ Helpline, and a refrigerator magnet with Smokers’ Helpline information.  The helpline attempted to have at least 4 contacts with each patient.  The investigators chose the three week interval before surgery because prior studies with higher intensity intervention demonstrated that a smoking intervention needs to begin at least four weeks before surgery to prevent postoperative complications due to smoking.

Twelve patients in the intervention group and three in the control group stopped smoking, defined as at least 7-day self-reported smoking abstinence and 6- to 24-hour abstinence measured using exhaled CO.  Intervention also helped patients reduce smoking: 34 in the intervention group vs 14 in the control group.  Thirty days postoperatively, 22 patients in the intervention group and 8 in the control group had stopped smoking.  Perioperative complications were no different between groups.  Time to PACU discharge readiness was lower in the intervention group.

Brief counseling worked, at least in the preoperative clinic at the University of Western Ontario. Our patients should not smoke.  Given the ease with which this preoperative clinic accomplished a useful smoking cessation intervention, there seems to be no reason other preoperative clinics could not do the same.

OpenAnesthesia has a discussion on smoking cessation and anesthesia.