Smoking cessation prior to gynecological surgery—A registry‐based randomized trial

Abstract

IntroductionSmoking cessation, both pre‐ and postoperatively, is important to reduce complications associated with surgery. Identifying feasible and effective means of alerting the patient before surgery to the importance of perioperative smoking cessation is a challenge to healthcare systems.Material and methodsA randomized registry‐based trial using the web‐version of the Swedish national quality register for gynecological surgery, GynOp, was performed (ClinicalTrials.gov NCT03942146). Current smokers scheduled for gynecological surgery were randomly assigned before surgery to group 1 (control group, no specific information), group 2 (web‐based written information), group 3 (information to doctor that the woman was a smoker and should be recommended smoking cessation or group 4 (a combination of groups 2 and 3). Perioperative smoking habits were evaluated in a postoperative questionnaire 2 months after surgery. The treatment effect was estimated to be a 15% reduction in the number of smokers at the time of surgery. Thus, 94 women in each group were required, in total 376 women, using a one‐sided test with an alpha level of 0.001 and a statistical power of 80%.ResultsParticipants (n = 1427) were recruited between 5 November 2015 and 6 December 2017. A total of 1137 smokers responded to the follow‐up questionnaire (80%), with 486 women declining to participate, leaving 651 women eligible for analysis. Women who received both web‐based information prior to surgery and information from a doctor, reported smoking cessation more often from 1 to 3 weeks preoperatively (Odds ratio [OR] 1.8, 95% confidence interval [CI] 1.0‐3.3) and 1 to 3 weeks after surgery (OR 1.9, 95% CI 1.1‐3.3) compared with the control group who received no specific information.ConclusionsA combination of written information in the health declaration and a recommendation from a doctor regarding smoking cessation may be associated with higher odds of smoking cessation at 1‐3 weeks pre‐ and postoperatively.

The effect of preoperative smoking and smoke cessation on wound healing and infection in post‐surgery subjects: A meta‐analysis

“…A total of 11 studies reported in 2002 and 2022 satisfied the inclusion criteria for the meta‐analysis among the 978 distinctive reports. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 This meta‐analysis study included 218 567 subjects after post‐surgery at the beginning of the study; 176 670 were smoke cessation or non‐smokers, and 41 897 were smokers. All studies evaluated the effect of preoperative smoking and smoke cessation on wound healing and infection in post‐surgery subjects.…”

“…A total of 11 studies reported in 2002 and 2022 satisfied the inclusion criteria for the meta‐analysis among the 978 distinctive reports 14‐24 . This meta‐analysis study included 218 567 subjects after post‐surgery at the beginning of the study; 176 670 were smoke cessation or non‐smokers, and 41 897 were smokers.…”

“…This meta‐analysis comprised 218 567 subjects after post‐surgery at the beginning of the study; 176 670 were smoke cessation or non‐smokers, and 41 897 were smokers. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 …”

“…This meta-analysis comprised 218 567 subjects after postsurgery at the beginning of the study; 176 670 were smoke cessation or non-smokers, and 41 897 were smokers. [14][15][16][17][18][19][20][21][22][23][24] Smoke cessation or non-smokers had significantly lower postoperative wound healing problems, and surgical site wound infection compared with smokers in postsurgery subjects. Yet, the analysis of results must be done with attention due to the low sample size of some of the selected studies found for the meta-analysis, 3 out of 11 studies with less than 100 subjects as sample size; recommending the necessity for additional studies to confirm these findings or perhaps to significantly impact confidence in the effect assessment.…”

Smoking Cessation for Preoperative Optimization

“…121,122 Surgeons should be encouraged that approaching patients about smoking cessation may pay dividends with respect to the effectiveness and durability of their efforts. [123][124][125]…”