Identifying and recruiting smokers for preoperative smoking cessation—a systematic review of methods reported in published studies

Abstract

BackgroundSmoking cessation before surgery reduces postoperative complications, and the benefit is positively associated with the duration of being abstinent before a surgical procedure. A key issue in providing preoperative smoking cessation support is to identify people who smoke as early as possible before elective surgery. This review aims to summarise methods used to identify and recruit smokers awaiting elective surgery.MethodsWe searched MEDLINE, EMBASE, CINAHL, and PsycINFO, and references of relevant reviews (up to May 2014) to identify prospective studies that evaluated preoperative smoking cessation programmes. One reviewer extracted and a second reviewer checked data from the included studies. Data extracted from included studies were presented in tables and narratively described.ResultsWe included 32 relevant studies, including 18 randomised controlled trials (RCTs) and 14 non-randomised studies (NRS). Smokers were recruited at preoperative clinics (n = 18), from surgery waiting lists (n = 6), or by general practitioners (n = 1), and the recruitment methods were not explicitly described in seven studies. Time points of preoperative recruitment of smokers was unclear in four studies, less than 4 weeks before surgery in 17 studies, and at least 4 weeks before surgery in only 11 studies. The recruitment rate tended to be lower in RCTs (median 58.2 %, range 9.1 to 90.9 %) than that in NRS (median 99.1 %, range 12.3 to 100 %) and lower in preoperative clinic-based RCTs (median 54.4 %, range 9.1 to 82.4 %) than that in waiting list-based RCTs (median 70.1 %, range 36.8 to 85.0 %). Smokers were recruited at least 4 weeks before surgery in four of the six waiting list-based studies and in only three of the 18 preoperative clinic-based studies.ConclusionsPublished studies often inadequately described the methods for recruiting smokers into preoperative smoking cessation programmes. Although smoking cessation at any time is beneficial, many programmes recruited smokers at times very close to scheduled surgery so that the benefit of preoperative smoking cessation may have not been fully effected. Optimal delivery of preoperative smoking cessation remains challenging, and further research is required to develop effective preoperative cessation programmes for smokers awaiting elective operations.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0152-x) contains supplementary material, which is available to authorized users.

Mandatory Nicotine Cessation for Elective Orthopedic Hip Procedures Results in Reduction in Postoperative Nicotine Use

“…Moller et al reported numerous complications from smoking tobacco including impaired wound healing, cardiopulmonary complications [9,10], and the need for postoperative intensive care [26]. Smoking cessation four weeks prior to surgery has been shown to positively affect the outcomes of patients and reduce surgical complications [15][16][17][18][19].…”

“…The Lower Extremity Assessment Project (LEAP) also found that in open fractures, smokers were twice as likely to develop an infection and 3.7 times more likely to develop osteomyelitis [14]. Evidence suggests that smoking cessation as early as four weeks preoperatively significantly reduces the 1 1 2, 3 4 1 5 likelihood of complications, although a timeline for the impact of cessation is lacking [15][16][17][18][19].…”

Impact of a standardized referral to a community pharmacist-led smoking cessation program before elective joint replacement surgery

“…We only used self-reported abstinence; however others have shown that self-report can produce results similar to CO monitoring 27,28 . We were unable to re-assess smoking cessation preoperatively because time to surgery was shorter than anticipated, but any tobacco reduction or cessation likely carries health benefits, even when not directly related to reducing postoperative complications 29,30 . Our approach could be enhanced by sending the smoking cessation program referral when booking the appointment with the surgeon to increase preoperative time to stop smoking.…”

Perioperative smoking cessation programs should be standard-of-care

“…3 A systematic review of perioperative smoking cessation interventions found lower rates of patient recruitment in randomized-controlled trials (RCTs) compared with observational studies; in the RCTs, there was a lower recruitment rate from preoperative clinics compared with surgical wait lists. 4 These observations suggest that buy-in from patients to participate in perioperative smoking interventions may be influenced even by the research setting.…”