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Interventions for preoperative smoking cessation.
Thordis Thomsen1, Nete Villebro, Ann Merete Møller
1Department of Anaesthesiology, Herlev University Hospital, Herlev Ringvej 75, Herlev, Denmark, 2730.
The Cochrane Database of Systematic Reviews
|July 9, 2010
Summary
Preoperative smoking interventions, including nicotine replacement therapy (NRT), significantly increase short-term smoking cessation and may reduce postoperative complications. Intensive interventions starting 4-8 weeks before surgery show the most promise for long-term cessation and complication reduction.
Area of Science:
- Medical research
- Public health
- Surgical outcomes
Background:
- Smokers face higher risks of postoperative complications.
- Surgery presents a critical opportunity for smoking cessation interventions.
Purpose of the Study:
- To evaluate preoperative smoking intervention effects on cessation rates at surgery and 12 months postoperatively.
- To assess the impact of these interventions on postoperative complication incidence.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) identified through specialized databases.
- Searched Cochrane Tobacco Addiction Group register, MEDLINE, EMBASE, and CINAHL for relevant studies.
- Included RCTs involving preoperative smokers, smoking cessation interventions, and measured outcomes of abstinence and/or complications.
Main Results:
- Eight trials (1156 participants) met inclusion criteria; most used brief interventions or nicotine replacement therapy (NRT).
- Preoperative interventions significantly increased short-term smoking cessation (pooled RR 1.41 for brief, 10.76 for intensive).
- Intensive interventions significantly improved long-term cessation (RR 2.96) and reduced overall (RR 0.42) and wound complications (RR 0.31).
Conclusions:
- Preoperative smoking interventions, particularly those including NRT, enhance short-term cessation and may lower postoperative morbidity.
- Optimal intervention intensity is unclear, but intensive programs (4-8 weeks pre-surgery, weekly counseling, NRT) appear most effective for long-term cessation and complication reduction.
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