Background: Smoking in the perioperative period increases postoperative morbidity and mortality, while abstinence just 24 hours before surgery is associated with significantly improved outcomes, including decreased rates of... [ view full abstract ]
Background:
Smoking in the perioperative period increases postoperative morbidity and mortality, while abstinence just 24 hours before surgery is associated with significantly improved outcomes, including decreased rates of ST depression and increased oxygen availability. While most patients are aware of the importance of smoking cessation, especially in the perioperative period, there are many obstacles to quitting for patients who identify as current smokers. There is evidence that patients are more receptive to smoking cessation counseling if it is provided by a physician. The UCSF Prepare Clinic, which sees a majority of patients prior to surgery, is poised in a unique position to provide formal smoking cessation interventions. Unfortunately, there is no formal smoking cessation intervention protocol in place. This project was designed to investigate provider practices and barriers to providing smoking cessation interventions in the Prepare Clinic, as well as to develop a feasible smoking cessation program for the Prepare Clinic.
Methods:
Prepare Clinic providers were surveyed anonymously using Qualtrics survey software to assess current smoking cessation practices and perceived barriers to providing smoking cessation interventions. Based on the survey results, we will design and implement a smoking cessation program for the Prepare Clinic.
Results:
Out of the 15 providers who responded, 8 reported that they “always” or “often” have smoking cessation conversations with patients who identify as current smokers, while 7 reported that they do so “sometimes,” “rarely,” or “never.” When asked what intervention they most often suggest, notable findings included that 33.3% reported nicotine replacement therapy, 14.3% reported in-person classes, and 4.8% reported telephone counseling. Among perceived barriers, providers reported that patients’ other health issues were more pressing, that there was not enough time during patients’ visits, and that there was uncertainty about which interventions to suggest. An analysis of the patients seen in Prepare Clinic revealed that a majority of patients are seen in the clinic within a week of surgery, many on the day before surgery. Based on the barriers found in our gap analysis, and that reaching patients as early as possible will have the greatest benefit for smoking cessation, we are targeting our intervention to occur prior to patients’ Prepare Clinic visits. Medical students working in coordination with the Prepare Clinic will call pre-surgical patients who are identified as active smokers and initiate brief smoking cessation conversations using motivational interview skills. If desired, they will make referrals to the UCSF Fontana Tobacco Treatment Center and the 1-800-NO-BUTTS hotline.
Conclusions:
Given the benefits of smoking cessation in the perioperative period and that surgery can be a powerful motivator for smoking cessation, smoking cessation counseling should occur preoperatively. There are multiple barriers for providers to consistently provide smoking cessation counseling, including the limited time they have with patients with which they must cover many health issues. Calling patients in advance of their surgeries has the benefit of giving patients more time to quit, while simultaneously overcoming the barriers identified in our provider survey. A future area of research will be evaluating the effectiveness of this intervention.
