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Smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. We studied 811 consecutive patients who had undergone hip or knee arthroplasty, recording current smoking and drinking habits, any history of chronic disease and such intraoperative factors as the type of anaesthesia and the type and duration of surgery. We recorded any postoperative complications occurring before discharge from hospital. There were 232 smokers (28.6%) and 579 non-smokers. We found that smoking was the single most important risk factor for the development of postoperative complications, particularly those relating to wound healing, cardiopulmonary complications, and the requirement of postoperative intensive care. A delay in discharge from hospital was usual for those suffering a complication. In those patients requiring prolonged hospitalisation (>15 days) the proportion of smokers with wound complications was twice that of non-smokers.

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Introduction: Preoperative smoking intervention programmes reduce postoperative complications in smokers. Little is known about the long-term effect upon smoking cessation. Aim: To discover long-term quit rates and the reasons behind successful cessation. Materials and Methods: 101 one of 120 smokers, randomised to smoking intervention or no intervention before hip and knee surgery, completed questionnaires concerning smoking after 1 year. We selected representative men and women for focus group interviews. Results: Significantly more patients from the intervention group abstained from smoking for 1 year post-operatively [13 in 60 patients (22%) vs 2 in 60 (3%), P < 0.01]. Sex (male), low nicotine dependency, non-smoking spouse and preoperative smoking intervention were related to smoking cessation. All patients gave the same reasons for smoking cessation: improved health and saving money. Follow-up for 5 years showed 17% of the controls and 8% in the intervention group (P = 0.42) had died. Conclusion:The intervention group had a significantly higher quit rate 1 year after a preoperative smoking cessation programme.Please cite this paper as: Villebro NM, Pedersen T, Møller AM and Tønnesen H. Long-term effects of a preoperative smoking cessation programme.

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SummaryMathematical formulae to calculate body surface area from measurements of height, weight and other parameters date from the late 19th century. Drug doses, fluid therapy, caloric requirements and physiological parameters such as cardiac output, glomerular filtration rate and a variety of respiratory function parameters are all frequently expressed in terms of a body surface area. Body surface area is often used in preference to body mass (weight). However, the original rationale for using body surface area as an estimate for metabolic rate has never been tested and the algorithms used to approximate body surface area have little evidence to support their use in this role. Recent developments in technology using indirect calorimetry allow easy measurement of metabolic rate in the clinical setting. Such measurements should be used for standardisation when weight alone is considered inadequate.Keywords Body surface area. Metabolic rate. Calorimetry. Rubner's Law, published in 1883, crystallised a belief among physiologists in the mid to late 19th century that, regardless of species, the heat production (i.e. metabolic rate) of an individual was proportional to the body surface area (BSA) [1]. This law was very difficult to disprove because BSA could only be measured by very cumbersome means, such as skinning the subject. Measurement of metabolic rate via direct calorimetry was possible but not widely available. Being unable to measure the metabolic rate in a clinical setting, measuring BSA seemed to provide an acceptable alternative to metabolic rate. There was an impetus around the beginning of the 20th century to derive simpler ways of calculating BSA using mathematical manipulations of various body dimensions. Throughout the remainder of the century, investigators attempted to simplify the equations and expand the application of the formulae. Because of the importance and widespread use of BSA formulae in many areas of medicine, we undertook a literature review to determine the source of and evidence for these equations. MethodsComprehensive literature reviews of documents published around 100 years ago are difficult. The electronic database ÔMedlineÕ only includes publications from 1966 onwards, whilst its paper-based predecessor, Index Medicus, extends to only 1960. The Medline database was searched by combining a medical subject heading (MeSH) search for Ôbody surface areaÕ, which prior to 1970 was classified under ÔanthropometryÕ. The following search strategies were used: MeSH search for ÔmathematicsÕ, or keyword searches for Ôcalculat*Õ, ÔformulaÕ or ÔduBoisÕ (duBois being the author of the most widely used BSA formula). Index Medicus was searched using the ÔanthropometryÕ MeSH term. Documents prior to 1960 were found from the references in articles identified by Anaesthesia, 2003, 58, pages 50-83 Ó 2003 Blackwell Publishing LtdMedline and each relevant document prior to 1960 also had its references searched. The development of Ôheight)weightÕ formulaeThe first published equation for estimating B...