Optimize perioperative health and begin with insistence on pre-operative smoking cessation

Haney, Michael; Löfvenberg, Richard; Svensson, Olle

doi:10.1111/aas.12242

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…78 Current smoking is also associated with an elevated risk of mortality in patients undergoing major surgery, 79 while discontinuation of smoking before surgery has a favourable impact on perioperative outcome. 80 Consequently, smoking cessation counselling and interventions should be implemented before surgery for all smokers with metabolic disturbances, such as diabetes, obesity, or dyslipidaemia. 81 Untreated hypertensive subjects have an increased risk for perioperative stroke, myocardial ischaemia, and renal failure.…”

Section: Metabolic Syndrome and Cognitive Dysfunctionmentioning

confidence: 99%

Impact of metabolic syndrome in surgical patients: should we bother?

Τζίμας

Petrou

Laou

et al. 2015

British Journal of Anaesthesia

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Clinicians inevitably encounter patients who meet the diagnostic criteria for the metabolic syndrome (MetS); these criteria include central obesity, hypertension, atherogenic dyslipidaemia, and hyperglycaemia. Regardless of the variations in its definition, MetS may be associated with adverse outcomes in patients undergoing both cardiac and non-cardiac surgery. There is a paucity of data concerning the anaesthetic management of patients with MetS, and only a few observational (mainly retrospective) studies have investigated the association of MetS with perioperative outcomes. In this narrative review, we consider the impact of MetS on the occurrence of perioperative adverse events after cardiac and non-cardiac surgery. Metabolic syndrome has been associated with higher rates of cardiovascular, pulmonary, and renal perioperative events and wound infections compared with patients with a non-MetS profile. Metabolic syndrome has also been related to increased health service costs, prolonged hospital stay, and a greater need for posthospitalization care. Therefore, physicians should be able to recognize the MetS in the perioperative period in order to formulate management strategies that may modify any perianaesthetic and surgical risk. However, further research is needed in this field.

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Section: Metabolic Syndrome and Cognitive Dysfunctionmentioning

confidence: 99%

Impact of metabolic syndrome in surgical patients: should we bother?

Τζίμας

Petrou

Laou

et al. 2015

British Journal of Anaesthesia

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“…Alcohol and smoking should be reduced and ceased preoperatively (7,8) to reduce the risk of infections, respiratory, and neurological complications and the intensive care unit (ICU) stay (9). Whether preoperative spirometry training is beneficial in patients undergoing thoracotomy and lung resection (10) and despite lacking data it should be recommended in patients for LVR.…”

Section: Preoperative Managementmentioning

confidence: 99%

Anaesthesia management for bronchoscopic and surgical lung volume reduction

Grande

Loop

2018

J. Thorac. Dis.

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“…This has led to initiatives within health care to make smokers cut down or stop smoking prior to elective surgery [ 10 ]. Such pre-surgery smoking cessation schemes have varied in the extent and kind of assistance offered (nicotine replacement therapy, varenicline and/or buproprione therapy, behavioural counselling or combined interventions) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“Right to recommend, wrong to require”- an empirical and philosophical study of the views among physicians and the general public on smoking cessation as a condition for surgery

2018

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BackgroundIn many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well as the reasons provided for this.MethodsA random sample of general practitioners and orthopaedic surgeons (n = 795) as well as members of the general public (n = 485) received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy.ResultsResponse rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains.ConclusionsThere is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”.Electronic supplementary materialThe online version of this article (10.1186/s12910-017-0237-2) contains supplementary material, which is available to authorized users.

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Optimize perioperative health and begin with insistence on pre-operative smoking cessation

Cited by 5 publications

References 6 publications

Impact of metabolic syndrome in surgical patients: should we bother?

Impact of metabolic syndrome in surgical patients: should we bother?

Anaesthesia management for bronchoscopic and surgical lung volume reduction

“Right to recommend, wrong to require”- an empirical and philosophical study of the views among physicians and the general public on smoking cessation as a condition for surgery

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