Helping patients butt out gets results

It’s one of the hardest habits to break but with just a little help at the right time, patients about to undergo surgery can be successfully convinced to butt out, a research study at St. Joseph’s Hospital in London has shown.

The study, published in the September issue of the prestigious journal Anesthesia and Analgesia, tested the effectiveness of a smoking cessation program offered to surgical patients attending the Preadmission Clinic at St. Joseph’s. It compared a control group of pre-surgical patients who were simply advised to stop smoking at least three weeks prior to surgery and provided with a pamphlet, to a treatment group that received a structured interview with a nurse trained to counsel patients on smoking cessation, brochures on the advantages of stopping smoking before surgery, a referral to Ontario’s ‘Smokers Helpline’, and a six-week supply of nicotine patches.

On the day of surgery, 14.3 per cent of patients in the treatment group had stopped smoking compared to 3.6 per cent in the control group, explains St. Joseph’s anesthesiologist Dr. Pat Morley-Forster.At the 30-day follow-up, the difference had increased further to 28.6 per cent in the treatment group and 11 per cent in the control group. As well, the treatment group was ready to be discharged earlier from the Post-Anesthesia Care Unit (PACU) after surgery.

“These differences were statistically significant,” says Dr. Morley-Forster, who is also an associate scientist at Lawson Health Research Institute. “Surgery is a teachable moment for patients and this shows that we can have a significant impact on motivating people to stop smoking at this critical time if they are given the right support.”

Smoking by surgical patients is associated with increased complications, particularly perioperative respiratory problems and pour wound healing. The purpose of the study was to determine if pre-surgery smoking cessation intervention designed for a busy preadmission clinic would be successful in reducing smoking rates and the complications associated with it.

Tracey Newman-Marshall was one of the first patients to take part in the study and has now been smoke free for nearly three years. She had tried to quit smoking several times without long-term success.

“It was like a rope was thrown out to me at exactly the right time,” says Newman-Marshall, who received knee surgery. “I was at a point where I wanted to make changes. The support provided to help me quit was phenomenal. Now I’m pain free and smoke free.”

Dr. Morley Forster collaborated with Dr. Philip Jones on the project. Both are faculty members of Western University’s Department of Anesthesia and Perioperative Medicine. The study took place at St. Joseph’s Hospital between October 2010 and April 2012 with 168 patients participating. Dr. Susan Lee and Dr. Jen Landry, both anesthesiology residents at the time of the study, were the primary investigators and first authors of the paper.

Follow up at the one year mark to see how many of the study patients continued to refrain from smoking is currently being compiled. Findings of the study are being shared with various hospital departments in the city with a goal of working towards making smoking cessation a priority for all patients.