Prospective Randomized Trial on Smoking Cessation in Orthopaedic Trauma Patients: Results From the Let’s STOP (Smoking in Trauma Orthopaedic Patients) Now Trial

Abstract

Intervention: Randomly assigned to control (no counseling), brief counseling (inpatient counseling), or extended counseling (brief counseling plus follow-up counseling) groups in a 1:3:3 ratio.Main Outcome Measurements: Smoking cessation confirmed by exhaled carbon monoxide at 3 and 6 months. Secondary outcomes are proportion accepting services from a nationally based quitline.Results: Overall, 266 patients participated, with 40, 111, and 115 patients in the control and 2 treatment groups, respectively. At 3 months, 17% of control patients versus 11% in the brief counseling and 10% in the extended counseling groups quit smoking, respectively (P = 0.45, 0.37). At 6 months, 15% of control, and 10% and 5% of the respective counseling groups quit (P = 0.45, 0.10). Extended counseling patients were 3 times more likely to accept referral to a quitline [odds ratio (OR), 3.1; 95% confidence interval (CI), 1.4-6.9], and brief counseling patients were more than 2 times as likely to accept referral (OR, 2.3; 95% CI, 1.0-5.1) than the control group. Extended counseling (OR, 8.2; 95% CI, 1.0-68.5) and brief counseling (OR, 5.3; 95% CI, 0.6-44.9) patients were more likely to use quitline services than the control group. Conclusion:Increasing levels of inpatient counseling can improve successful referral to a smoking quitline, but it does not seem to influence quit rates among orthopaedic trauma patients. Extended counseling does not appear to provide substantial benefit over brief counseling.

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

“…We identified 170 citations for full‐text review. Thirty‐eight studies are included in the systematic review (Tables 1 and 2) [6, 16, 17, 20‐23, 39‐68]. Detailed descriptions of the interventions and outcomes are in online Supporting Information Table S3.…”

Pulmonary prehabilitation and smoking cessation

“…Counseling includes physician advice, motivational interviews by healthcare professionals, and cognitive behavioral therapy offered in person, over the telephone, for example, via quitlines or e-learning platforms. The use of counseling alone without pharmacotherapy to achieve smoking cessation has limited, mixed results [47 ▪ ,48,49]. Counseling via quitlines is a practical, widely accessible mode of counseling to a large group of people and aids in successful smoking cessation.…”

“…However, success may hinge on other variables, including readiness to quit and the number of smoking pack-years. The utilization of quitlines initiated before thoracic surgery augments successful smoking cessation in the short-term and long-term [50]; however, there was no observed effect in a population of orthopedic trauma patients [47 ▪ ]. In the general population, there is limited evidence of the frequency of calls associated with successful abstinence although the likelihood of success may be dose-dependent [48] (Fig.…”

What’s New in Orthopaedic Trauma

“…Orthopaedic surgeons have a role in counseling patients to quit smoking, but success has varied. Matuszewski et al 29 published a randomized controlled trial of various counseling programs and their effect on smoking cessation, as measured by exhaled carbon monoxide at 3 and 6 months. Smokers with operatively treated fractures were assigned to no counseling in a control group (n = 40), brief inpatient counseling (n = 111), or extended counseling (n = 115).…”