One year later, preoperative quit-smoking program still shows benefits

The simple, inexpensive program triples the percentage of patients with long-term smoking cessation at one year after surgery, according to the study by Dr Susan M. Lee and colleagues of University of Western Ontario, London, Canada. They write, "Anesthesiologists and perioperative providers have a unique opportunity to help patients achieve both short-term and long-term smoking cessation."

Brief Intervention Has Lasting Effect on Smoking Cessation

The researchers performed a follow-up study of 168 patients from a previous randomized trial evaluating a "practical intervention" to help smokers quit before surgery. Three weeks before scheduled elective procedures, one group of patients received the smoking cessation program. The four-part programs consisted of brief counseling (less than five minutes) by a nurse, brochures on smoking cessation, referral to a quit-smoking hotline, and a free six-week supply of nicotine patches.

Patients in the control group received usual care. As reported last year in Anesthesia & Analgesia, about 14 percent of patients in the intervention group were confirmed as quitting smoking before surgery, compared to just four percent of the control group.

For the new study, Dr Lee and colleagues performed follow-up interviews with 127 of the patients. One year after surgery, 25 percent of patients in the intervention group said that they were no longer smoking, compared to eight percent in the comparison group. (The patient reports were not confirmed by testing in the follow-up study.)

On adjusted analysis, patients in the intervention group were three times more likely to be nonsmokers at one year. For every six patients enrolled in the program, one additional patient had achieved long-term smoking cessation. The effect remained significant even assuming that all patients lost to follow-up continued to smoke.

Patients with lower scores for nicotine dependence were six times more likely to be successful long-term quitters. None of 22 patients with chronic obstructive pulmonary disease, a lung disease usually caused by smoking, were able to achieve long-term cessation -- although this wasn't a statistically significant predictor. Smoking history in "pack years" also didn't predict one-year smoking status.

Surgery a 'Teachable Moment' to Help Smokers Quit

Patients who smoke are at increased risk of surgical complications -- particularly problems with wound healing and breathing-related complications. Anesthesiologists commonly evaluate patients before surgery, providing a chance to inform smokers about their excess risk, and to encourage them to stop smoking before their operation.

"Undergoing surgery can serve as a 'teachable moment' that may motivate patients to engage in permanent smoking cessation," Dr Lee and colleagues write. The original trial results found that the brief intervention increased the number of patients who quit smoking before surgery, at relatively low cost and without taking too much time away from doctors and nurses in busy preadmission clinics.

The new results show lasting benefits of the brief intervention, increasing patients' chances of being nonsmokers one year after surgery. Providing patients with nicotine patches to help them quit was a "vital component" of their program's success, Dr Lee and colleagues believe. They add, "Our study...may serve as a call to action for governments and health insurers to take advantage of the teachable moment, and support more widespread funding of drugs for smoking cessation therapy around the time of surgery."