Peri‐operative tobacco cessation interventions: a systematic review and meta‐analysis

Abstract

SummaryTobacco smoking is associated with a substantially increased risk of postoperative complications. The peri‐operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long‐term health. This systematic review provides an up‐to‐date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri‐operative period. Quantitative synthesis of the abstinence outcomes data was by random‐effects meta‐analysis. The primary outcome of the meta‐analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty‐eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta‐analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri‐operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri‐operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20–1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29–2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.

Preoperative Risk Factors for Pain After Reverse Total Shoulder Arthroplasty: A Systematic Review

“…As the studies demonstrated better postoperative pain among former smokers compared to current smokers, this suggests smoking cessation or reduction would be of benefit by allowing for better short-term pain management and improved postoperative outcomes [38]. A recent systematic review by Harrogate et al assessing perioperative smoking cessation interventions highlights the effectiveness these programs have at facilitating smoking cessation, both at the time of surgery and 12 months after surgery [39]. In addition, patients with chronic pain and long-term opioid use may benefit from pain clinic referrals prior to surgical intervention to optimise their analgesic use and consider attempting opioid weaning [40].…”

Does offering small financial incentives to smokers at the time of being wait-listed for surgery increase smoking cessation by the day of surgery? A randomised feasibility trial

“…Strengths include this being among the largest of all perioperative cessation trials. 4 Inclusion of all eligible smoker is another as it showed the real effect of the intervention on a population. Trials randomising only after consenting comprise the vast majority of studies, 7 19 yet may overestimate the incentive population effect by including subsets with better prognostic features.…”

“… 3 4 However, such studies show great heterogeneity and further studies are needed to determine cessation strategies that are acceptable, effective and easily incorporated into elective surgical pathways. 4 Because longer cessation confers greater benefits, we previously trialled whether offering free mailed nicotine replacement therapy (NRT) plus telephone Quitline referral at time of wait-listing for elective surgery increased perioperative abstinence. 5 6 When offered this help, between 32% 6 and 39% 5 of smokers requested it (costing approximately $A70 (£37, €42, US$45) per acceptance), resulting in approximately doubling verified abstinence compared with standard care.…”

“…3 4 However, such studies show great heterogeneity and further studies are needed to determine cessation strategies that are acceptable, effective and easily incorporated into elective surgical pathways. 4 Because longer cessation confers greater benefits, we previously trialled whether offering free mailed nicotine…”

Intensive Intervention on Smoking Cessation in Patients Undergoing Elective Surgery: The Role of Family Physicians

“…Additionally, Musallam reported that smoking cessation at least one year before a major surgery reduces the risk of postoperative mortality [ 12 ]. The evidence from a systematic review and meta-analysis of 38 randomised controlled trials suggests that perioperative SCIs lead to an increase in abstinence rates for up to 12 months following the surgical procedure [ 13 ]. The current evidence-based interventions for smoking cessation encompass behavioural treatments, quit lines, web-based support services, and pharmacotherapy.…”