A Perioperative Smoking Cessation Intervention With Varenicline, Counseling, and Fax Referral to a Telephone Quitline Versus a Brief Intervention: A Randomized Controlled Trial

Wong, Jean; Abrishami, Amir; Riazi, Sheila; Siddiqui, Naveed; You-Ten, Eric; Korman, Jennifer; Islam, Sazzadul; Chen, Xin; Andrawes, Maged; Selby, Peter; Wong, David T.; Chung, Frances

doi:10.1213/ane.0000000000001894

Cited by 33 publications

(48 citation statements)

References 34 publications

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“…In addition to direct counselling, telephone quit-lines and patient e-learning programs providing both preoperative and postoperative support improve quit rates. 2,3 For pharmacotherapy other than nicotine replacement, varenicline and bupropion have been shown to help patients quit smoking perioperatively. 4,5 None of these additional interventions were utilized in the included studies and should be considered in future multimodal prehabilitation trials.…”

Section: To the Editormentioning

confidence: 99%

Preoperative smoking cessation as part of surgical prehabilitation

Ayob

Rajaleelan

et al. 2019

Can J Anesth/J Can Anesth

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There is a growing interest in multimodal prehabilitation programs prior to surgery. Several recent guidelines have recommended multimodal prehabilitation programs that include smoking cessation. While preoperative smoking cessation programs reduce perioperative complications and increase long-term abstinence, 1 the impact of smoking cessation interventions as part of multimodal prehabilitation programs has not been described. As such, we performed a systematic review to summarize the literature on prehabilitation programs that have included smoking cessation.A literature search was performed in April 2018 of Medline, Medline In-Process, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed-NOT-Medline, CINAHL, Web of Science, and Scopus. Studies that evaluated the effect of preoperative smoking cessation as part of surgical prehabilitation were included.The literature search identified seven studies for inclusion (Table). Five studies were observational studies and two were randomized-controlled trials. The study populations included patients undergoing elective thoracic, abdominal, and orthopedic surgeries. Interventions generally consisted of a combination of aerobic exercise, strength training, pulmonary rehabilitation, and lifestyle modification including smoking cessation.Five studies assessed the effect of their interventions on postoperative outcomes. Three studies found an improvement in outcomes, primarily a reduction in postoperative pulmonary complications and hospital length of stay; however, two other studies failed to show a reduction in postoperative pulmonary complications.Three studies examined the effect of the intervention on exercise capacity and health-related quality of life. The results show that the interventions can effectively improve exercise capacity; however, the results for quality of life were inconsistent.Three studies reported the number of current smokers undergoing the intervention that quit smoking preoperatively, with abstinence rates from 46-100%. The results show that the interventions resulted in a high smoking abstinence rate prior to surgery; however, longterm abstinence was not measured in any of the studies.Even though the evidence suggests some beneficial effects, the evidence for smoking cessation interventions in the context of multimodal prehabilitation programs is limited. Most of the studies were observational, and only two were randomized studies with small sample sizes. The studies were heterogeneous with regards to the surgical population, types of interventions, and outcomes. Most of the studies did not start the smoking cessation intervention early enough (at least four weeks before surgery-the minimum period shown to reduce postoperative complications). 1 Most importantly, as no study compared prehabilitation programs with and without smoking cessation, we are not able to identify the specific benefits

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Section: To the Editormentioning

confidence: 99%

Preoperative smoking cessation as part of surgical prehabilitation

Ayob

Rajaleelan

et al. 2019

Can J Anesth/J Can Anesth

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“…For example, an anaesthetist-administered brief smoking-cessation intervention was associated with 26% new abstinence at 6 months. 25 Perhaps anaesthetists should be promoting uptake of guideline-advised statin treatment.…”

Section: How Can Anaesthetists Contribute?mentioning

confidence: 99%

Perioperative statins surgery and postoperative pain

Sneyd¹,

Columb

Nightingale³

2017

British Journal of Anaesthesia

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“…Исключено 21 исследование, оценивавшее эффективность варени-клина среди пациентов с психиатрическими заболеваниями и зависимостями, а также с ВИЧ [3, 16, 25, 29, 32, 49, 53, 66-68, 70, 71, 75, 80, 81, 85, 86, 94, 103, 110, 114]. Исключены исследования, в которых основными точками оценки эффективности служила семидневная абстиненция [20,30,60,95,105,115,117]. Исключены две работы, в которых абстиненцию определяли как полное воздержание от курения за последние 4 недели, а не за весь период с начала отказа от курения [24,61].…”

Section: Introductionunclassified

“…Исключены работы, где в фокусе внимания было влияние варениклина на отказ от других форм табака [21,28,51]. Кроме того, исключено исследование Wong (2017), в котором подход к лечению в группах был неоднороден: группа терапии варениклином получала доступ к телефонной линии, группа плацебо получала только краткую консультацию [117]. Исключено исследование, сравнивающее комбинацию варениклина и когнитивной терапии против когнитивной терапии отдельно [14].…”

Section: Introductionunclassified

Network meta-analysis: a comparison of effectiveness and safety of partial agonists of nicotinic acetylcholine receptors varenicline and cytisine for smoking cessation

Radchenko

Владимировна²,

Sykhovskaya

et al. 2018

Rev Clin Pharm Drug Ther

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Background. Partial agonists of α4b2 nicotinic acetylcholine receptors are the most effective treatment strategy for tobacco smoking cessation. They are able to alleviate withdrawal symptoms and to reduce smoking satisfaction. The aim of this study was to review the efficacy and safety of nicotinic receptor partial agonists varenicline and cytisine, for smoking cessation. Methods. A search for randomized controlled trials was done using the terms (“cytisine”, “tabex”, “varenicline” or 'partial agonists of nicotinic receptors’) in MEDLINE, EMBASE, eLibrary in May 2018. Types of participants, the doses and duration of the treatments, efficacy and safety parameters, quality of randomization and blinding procedures were evaluated. Bayesian network meta-analysis was performed. Results. Cytisine overcame placebo in the 12, 24 and 52 weeks of therapy with the following odds ratios (ORs) for abstinence: 3.3 (95% CrI 1.8–5.8), 3.9 (2.4–6.7), 3.8 (CrI 1.3–11,9) accordingly. Varenicline in 2 mg/day dose overcame placebo in the 12, 24 and 52 weeks of therapy with the ORs: 4.0 (3.3–4.7), 3.1 (2.5–3.7), 2.9 (2.2–4.1) accor dingly. Varenicline in 1 mg/day dose overcame placebo in 12 and 52 weeks of therapy, the ORs were 3.0 (2.0–4.7) and 2.3 (1.3–4.4) accordingly. Varenicline in 0.5 mg/day dose overcame placebo in 12 weeks of therapy only with the OR 2.4 (1.3–4.4). Cytisine and varenicline 2 mg/day were associated with more gastrointestinal disturbances than placebo with the ORs 6.2 (2.1–22.8) and 2.4 (2.0–2.8) accordingly. Cytisine and varenicline 2 mg/day were associated with more psychiatric problems than placebo with ORs 5.2 (1.9–15.1) and 1.6 (1.3–1.9) accordingly. There was no difference in serious adverse events between the investigated drugs and placebo: OR for cytisine was 2.4 (0.8–6.8), varenicline 0.5 mg/day – 2.0 (0.5–6.6), varenicline 1.0 mg/day – 1.0 (0.3–2.7), varenicline 2 mg/day – 1.0 (0.7–1.4). Conclusion. Cytisine was proved to be as effective and safe aid for smoking cessation as varenicline.

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A Perioperative Smoking Cessation Intervention With Varenicline, Counseling, and Fax Referral to a Telephone Quitline Versus a Brief Intervention: A Randomized Controlled Trial

Abstract: A perioperative smoking cessation program with counseling, pharmacotherapy with varenicline, an educational pamphlet, and a fax referral to a quitline increased abstinence from smoking 1, 3, 6, and 12 months after surgery versus a brief intervention.

Cited by 33 publications

References 34 publications

Preoperative smoking cessation as part of surgical prehabilitation

Preoperative smoking cessation as part of surgical prehabilitation

Perioperative statins surgery and postoperative pain

Network meta-analysis: a comparison of effectiveness and safety of partial agonists of nicotinic acetylcholine receptors varenicline and cytisine for smoking cessation

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