Smokers know little of their increased surgical risks and may quit on surgical advice

Abstract

Background: Smoking cessation before surgery improves perioperative outcomes and some smokers may quit if undergoing surgery. Quitting smoking in community settings is influenced by physician quit advice and knowledge of smoking hazards, but there are few data on whether this applies in perioperative settings. Method: Survey on day of surgery of elective patients who reported being a smoker at the time of wait-list placement. Duration of smoking abstinence before surgery (if any) and length timing of failed quit attempts was determined. Sources of any quit advice before surgery, including from physicians, and patient knowledge on hazards of smoking and surgery were questioned. Results: While on the waiting list, 44/177 smokers reported quitting (>24 h) before surgery and 42/177 others made an attempt. Quitting was usually brief. Fewer than 40% of smokers answered yes (correct answer) to questions on whether smoking increased wound infection rates, worsened wound healing, increased anaesthetic complications or increased post-operative pain. Incorrect answers (no) were less likely in quitters than those smoking until surgery (OR 0.41, 95% CI 0.25-0.68). Patients still smoking by admission recalled quit advice from a surgeon in 22.6% of cases, while wait-list quitters recalled surgical quit advice in 43.2% of cases (OR 2.6 95% CI 1.2-5.4 P = 0.01). Effects of general practitioner quit advice were significant (OR 3.2 95% CI 1.5-6.8 P = 0.004) while anaesthetists, nurse and hospital brochure advice were not. Discussion: Improving patient knowledge of the perioperative risks of smoking and increased physician advice to quit may improve smoking abstinence at surgery.

How Can Smoking Cessation Be Induced Before Surgery? A Systematic Review and Meta-Analysis of Behavior Change Techniques and Other Intervention Characteristics

“…The benefits of stopping smoking before surgery are substantially different, and may be realized sooner, than the benefits from smoking cessation in patients who are not scheduled to have operations. Surveys of smokers' knowledge suggest that they are aware of the general health risks of smoking, but under-appreciate that there are specific peri-operative risks (Webb et al, 2013; Bottorff et al, 2015). However, when controlling for other BCTs which were often delivered alongside BM1, the effects drifted to non-significance.…”

Perioperative tobacco use treatments: putting them into practice

“…10 Concerns that perioperative abstinence will exacerbate psychological stress or that patients will be offended if clinicians address their tobacco use are baseless. [101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116][117] What implementation process should be followed? Although descriptions of tobacco treatment implementation in clinical settings are available, none has been evaluated within an implementation science framework.…”

Peri‐operative cessation of smoking: time for anaesthetists to act

“…It has been suggested that the pre‐operative visit and peri‐operative period are an opportunity for a ‘teachable moment’ for smoking cessation interventions . Many smokers are not aware that smoking increases their risks of anaesthetic and surgical complications . When smokers were educated about the increased risks of postoperative complications, they were more likely to attempt to quit (Raveendran R, Islam S, Chung F, Wong J.…”