Re: Printed quit-pack sent to surgical patients at time of waiting list placement improved perioperative quitting

Abstract

Re: Printed quit-pack sent to surgical patients at time of waiting list placement improved perioperative quittingWe read with interest the recent paper by Webb et al. that described the utility of a written 'quit-pack' intervention to increase smoking cessation prior to elective surgery. 1 This before-and-after study highlights an important area of modifiable patient-related risk factor optimization that can be achieved by using a simple and costeffective intervention. However, we would like to offer a few additional points.First, recent evidence from the UK reports that smoking is significantly more prevalent among those from socio-economically deprived areas. 2 Adult smokers in more deprived areas are also more likely to smoke more heavily than smokers from more affluent areas. 3 In addition, adults from the most deprived areas are also more likely to have higher rates of functional illiteracy. 4 Therefore, an intervention based on printed written material to promote smoking cessation may be of limited impact among patients who are at highest risk. Other methods including the provision of information on DVD or podcast, engaging medical professionals to perform face-to-face brief opportunistic interventions or regular reminders via text messaging may further improve rates of perioperative smoking cessation.Second, no clinical outcome measures were presented in this study. It would have been interesting to know if the 'quit-pack' intervention led to any significant differences in post-operative complications or mortality. Extended follow-up of smoking prevalence rates among study participants would also have been useful to evaluate this interventions usefulness in promoting longer term smoking cessation.Improving the modifiable risk factor profile of elective surgical patients using this simple, cost-effective intervention should be encouraged and the authors should be commended for their work. However, the limitations of the 'quit-pack' as detailed should be kept in mind. Further work is clearly required to optimize strategies to reduce smoking prevalence perioperatively with the overall aim of improving surgical outcomes. References1. Webb AR, Robertson N, Sparrow M, Borland R, Leong S. Printed quitpack sent to surgical patients at time of waiting list placement improved perioperative quitting. ANZ J. Surg. 2014; 84: 660-4. 2. Office for National Statistics. Do smoking rates vary between more or less advantaged areas? [Cited 12 Mar 2014.] Available from URL:www.ons.gov.uk/ons/rel/disability-and-health-measurement/do-smoking -rates-vary-between-more-and-less-advantaged-areas-/2012/sty-smoking -rates.html 3. Bromley C, Given L. The Response to Re: Printed quit-pack sent to surgical patients at time of waiting list placement improved perioperative quittingWe thank Byrne et al. for raising important points regarding how best to help smokers quit before surgery. 1 Smoking rates among the poorest 20% of Australians are approximately three times higher than the wealthiest 20%, and rates of adequate health literacy are...