E-cigarettes versus nicotine patches for perioperative smoking cessation: a pilot randomized trial

Abstract

IntroductionCigarette smoking by surgical patients is associated with increased complications. E-cigarettes have emerged as a potential smoking cessation tool. We sought to determine the feasibility and acceptability of e-cigarettes, compared to nicotine patch, for perioperative smoking cessation in veterans.MethodsPreoperative patients were randomized to either the nicotine patch group (n = 10) or the e-cigarette group (n = 20). Both groups were given a free 6-week supply in a tapering dose. All patients received brief counseling, a brochure on perioperative smoking cessation, and referral to the California Smokers’ Helpline. The primary outcome was rate of smoking cessation on day of surgery confirmed by exhaled carbon monoxide. Secondary outcomes included smoking habits, pulmonary function, adverse events, and satisfaction with the products on day of surgery and at 8-weeks follow-up.ResultsBiochemically verified smoking cessation on day of surgery was similar in both groups. Change in forced expiratory volume in one second (FEV1) was 592 ml greater in the e-cigarette group (95% CI [153–1,031] ml, p = 0.01) and change in forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC ratio) was 40.1% greater in the e-cigarette group (95% CI [18.2%–78.4%], p = 0.04). Satisfaction with the product was similar in both groups.DiscussionE-cigarettes are a feasible tool for perioperative smoking cessation in veterans with quit rates comparable to nicotine replacement patch. Spirometry appears to be improved 8-weeks after initiating e-cigarettes compared to nicotine patch, possibly due to worse baseline spirometry and more smoking reduction in the e-cigarette group. An adequately powered study is recommended to determine if these results can be duplicated.

Smoking Effects in Foot and Ankle Surgery: An Evidence-Based Review

“…A clinical trial comparing ENDS with traditional nicotine replacement patches for perioperative smoking cessation found that both methods were similarly effective. 23 Biochemically verified smoking cessation for 2 days preoperatively was achieved in 20% of patients in the nicotine patch group compared with 15% in the ENDS group ( P ≥ .999). Quit rates at 30 days postoperatively were 30% and 25%, respectively, which is similar to rates published using other cessation strategies.…”

E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis

“…associated with significantly increased smoking cessation in randomized clinical trials of e-cigarettes as smoking cessation therapy. Nine RCTs [16][17][18][19][73][74][75][76][77] were included for analysis. In 7 of the 9…”

“…RCTs, the control group was provided free cessation aids 16,17,19,73,74,76,77 ; 2 RCTs provided the control group with smoking cessation counseling only. 18,75 In Figure 4 and Table 2).…”

“…When determining whether a new tobacco product is appropriate for the protection of the public health, TCA §910(c)(4) requires FDA to consider the risks and benefits to the population as a whole including users and nonusers of the tobacco product, and taking into account (A) the increased or decreased likelihood that existing users of tobacco products will stop using such products; and (B) the increased or decreased likelihood that those who do not use tobacco products will start using such products. 77 Halpern et al 16 Hajek et al 73 Lee et al 76 Lucchiari et al 18 Walker et al 19 Hatsukami et al 74 Holliday et al 75 Bullen et al 17 Lee et al 77 Halpern et al 16 Hajek et al 73 Lee et al 76 Lucchiari et al 18 Walker et al 19 Hatsukami et al 74 Holliday et al 75 Bullen et al 17 1 extent that people who smoke simply add e-cigarettes to their cigarette smoking (becoming so-called dual users), their risk of heart disease, [80][81][82][83] lung disease, 84,85 and cancer 86 disease, [80][81][82][83]92 lung disease, 84,85,93,94 and cancer. 86,95,96 By contrast, the RCTs suggest that however, also requires that they be "safe," meaning that the benefit-to-risk ratio must be favorable.…”

Electronic Cigarettes and Smoking Cessation in the Perioperative Period of Cardiothoracic Surgery: Views of Australian Clinicians

“…This precautionary approach towards electronic cigarettes has been echoed in policy documents and recommendations from medical and health authorities in Australia citing concerns about the unknown health risks of electronic cigarettes for the general population [ 34 , 35 , 36 , 37 ]. However, this approach may place limitations on the use of electronic cigarettes in specific clinical populations and scenarios, such as around the time of surgery to reduce the perioperative harm caused by tobacco smoking [ 38 , 39 , 40 ].…”