Anesthesiologists, General Surgeons, and Tobacco Interventions in the Perioperative Period

Abstract

Surgery presents an opportunity for interventions in cigarette smokers that will facilitate abstinence from tobacco. However, little attention has been paid to the role of anesthesiologists and surgeons in addressing tobacco use. To determine the practices and attitudes of these physicians regarding this issue, we sent a postal mail survey to a national random sampling of anesthesiologists and general surgeons engaged in active practice within the United States (1000 in each group). Response rates were 33% and 31% for anesthesiologists and surgeons, respectively. More than 90% of both groups almost always ask their patients about tobacco use, and almost all respondents believed that surgical patients should maintain abstinence after surgery. Most believed that it was their responsibility to advise their patients to quit smoking, but only 30% of anesthesiologists and 58% of surgeons routinely do so. Nonetheless, approximately 70% of both groups would be willing to spend an extra 5 min before surgery to help their patients quit. Barriers to intervention included a lack of training regarding intervention techniques, a perceived lack of effective interventions, and insufficient time to intervene. Intervention opportunities are not exploited consistently in the surgical population; educational efforts directed at physicians in surgical specialties are indicated.

Clinician-delivered Intervention to Facilitate Tobacco Quitline Use by Surgical Patients

“…At 90 days, for those patients who could be contacted and who reported smoking (n ϭ 152), 40% planned to initiate a sustained quit attempt within 30 days, 38% planned to quit within 6 months, and 22% did not plan to initiate a quit attempt within 6 months; these proportions were similar to those present in the general population. 17 Consistent with previous studies, at the preoperative evaluation, many subjects were willing to contemplate at least some period of postoperative abstinence, 6 given that elective surgery can serve as a powerful teachable moment for smoking cessation 3 ; this may have contributed to the high enrollment rate.…”

“…Despite these desirable features, the current use of quitlines is low, 16 with a median annual use rate among eligible smokers of 1.2% in 2008 (North American Quitline Consortium Annual Survey of Quitlines; oral personal communication, 2009, Jessie Saul, Ph.D., Director of Research, North American Quitline Consortium, Phoenix, AZ); and increasing their reach has proved challenging. Given the many smokers undergoing elective surgery each year in the United States, 3 and the challenges of introducing tobacco interventions into a busy clinical environment in which such interventions are rare, 6 the AskAdvise-Referral to quitline method is potentially attractive. In this study, we proposed and developed the novel approach that this method should focus on clinicians facilitating the use of quitlines in the surgical setting, rather than providing direct assistance to quitting.…”

“…However, some of the elements of the 5As, especially Assist and Arrange, have often proved difficult, if not impossible, for busy clinicians to implement in their prac-tices; this was specifically shown for surgeons and anesthesiologists. 6 This has prompted increased interest in using telephone quitlines, now available in all 50 states and the District of Columbia, to provide assistance and follow-up to smokers attempting to quit. 7 Some have recommended that rather than trying to provide all elements of the 5As themselves, clinicians should ask their patients about tobacco use, advise them to quit, and refer them to a telephone quitline.…”

Smoking cessation interventions in the pre-admission clinic: assessing two approaches

“…Second, a more sustained period of follow-up counselling may have been required to reveal the added benefit of brief motivational counselling. 9 Third, from a methodological perspective, intensity of the cessation intervention was confounded by hospital site. We observed no demographic differences among patients receiving each RMR intervention, but other hospital factors may have confounded our comparison of the primary outcome measure across sites.…”

“…8 In the case of surgical patients, only a minority of anesthesiologists, surgeons, and nurses actively assist their patients to quit smoking or develop a plan to manage the consequences of involuntary perioperative cessation. 9 We attempted to address this deficit in 2004 by developing a brief intervention (BI) smoking cessation program, ''Reduce My Risk'' (RMR), at the University of Alberta Hospital Pre-Admission Clinic (PAC). The BI was based on the 5As model (i.e., Behaviour Change Counselling Model): Ask, Advise, Assess, Assist, and Arrange (for follow-up).…”