Interventions for preoperative smoking cessation.
Thordis Thomsen1, Nete Villebro, Ann Merete Møller
1Abdominal Centre, 3133, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark, 2100.
The Cochrane Database of Systematic Reviews
|March 28, 2014
Summary
Preoperative smoking interventions, especially intensive ones with behavioral support and nicotine replacement therapy (NRT), significantly increase short-term smoking cessation and reduce postoperative complications. Intensive interventions show a greater impact on long-term cessation and reducing surgical morbidity.
Area of Science:
- Clinical Medicine
- Public Health
- Addiction Medicine
Background:
- Smokers face significantly higher risks of postoperative complications.
- Surgery presents a critical opportunity for implementing smoking cessation interventions.
- Preoperative smoking cessation interventions may effectively reduce surgical complication rates.
Purpose of the Study:
- To evaluate the effectiveness of preoperative smoking intervention on smoking cessation rates at surgery and 12 months postoperatively.
- To assess the impact of preoperative smoking intervention on the incidence of postoperative complications.
- To compare the efficacy of different intervention intensities (brief vs. intensive) and pharmacological aids.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched Cochrane Tobacco Addiction Group Specialized Register for relevant trials.
- Included RCTs involving smokers undergoing surgery, offering cessation interventions, and measuring abstinence or complications.
Main Results:
- Intensive preoperative smoking interventions (behavioral support + NRT, starting 4+ weeks pre-surgery) significantly increased short-term cessation (RR 10.76) and reduced postoperative complications, including wound complications (RR 0.31).
- Brief interventions showed a smaller effect on short-term cessation (RR 1.30) and no significant reduction in postoperative complications.
- Varenicline showed a benefit for long-term cessation in one trial but not for short-term cessation or complications; nicotine lozenges showed no significant short-term cessation benefit.
Conclusions:
- Preoperative smoking interventions combining behavioral support and nicotine replacement therapy (NRT) enhance short-term cessation and may decrease postoperative morbidity.
- Intensive interventions, initiated 4-8 weeks pre-surgery with weekly counseling and NRT, appear most effective for reducing complications and achieving long-term cessation.
- The optimal intensity and timing of preoperative smoking interventions require further investigation, but early, intensive approaches show promise.
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