Evaluation of a smoking cessation service in elective surgery

No best practice service models exist for promoting preoperative smoking cessation support, despite smokers experiencing more perioperative complications than nonsmokers. A novel specialist stop smoking service for patients undergoing elective surgery (called 'ELECT') was established in 2012 in Auckland, New Zealand (NZ). An evaluation of the service was undertaken in 2014.

The ELECT service involved regular staff training and the development of setting-specific and easy-to-use referral procedures. Cessation treatment emphasized temporary abstinence around the time of surgery, as opposed to long-term smoking abstinence. Information on referral rates and cessation outcomes were collated for the evaluation. Summary statistics are reported, with multiple logistic regression analysis undertaken to determine key associations between outcome variables.

A total of 527 patients were referred to ELECT over a 27 mo period, representing one-fifth of all identified smokers. Nearly 60% (n = 308) of those referred received at least one treatment session involving intense behavioral support and nicotine replacement treatment; for Māori (indigenous NZers), this figure was 75%. A shorter time to contact of referred patients, older age, being Māori (versus NZ European) and being referred through the surgical hospital services were all positively associated with likelihood of receiving at least one treatment session (P < 0.05). Of the 123 patients who set a formal quit date, 68% (n = 82) self-reported sustained abstinence 4 wk post-quit, and 48% (n = 58) were still abstinent 12 wk post-quit.

The ELECT service appears both feasible and sustainable over time and has a clear impact on helping patients achieve smoking abstinence.