Background: Smoking in the perioperative period increases postoperative morbidity and mortality, costing the US healthcare system >$10 billion annually. However, just 12-24 hours of smoking cessation before surgery reduces... [ view full abstract ]
Background: Smoking in the perioperative period increases postoperative morbidity and mortality, costing the US healthcare system >$10 billion annually. However, just 12-24 hours of smoking cessation before surgery reduces tobacco-related risk of cardiovascular complications by 50% and cessation for 4 weeks reduces risk of pulmonary complications by 23%. Prior studies found patients are more likely to abstain from smoking if cessation advice is given by a physician. The perioperative period provides a critical opportunity for smoking cessation interventions. The goal of this project was to investigate what barriers to smoking cessation exist for patients in the perioperative period.
Methods: We identified patients who were smokers and underwent surgery at UCSF’s Parnassus, Mission Bay, and Mount Zion hospitals from September 2016 to January 2017. To meet inclusion criteria, patients had to be current smokers, English speaking, and at least a month post-surgery. We conducted a structured telephone interview regarding patient barriers to smoking cessation and clinician counseling in the perioperative period.
Results: Of 143 patients that met inclusion criteria, 40 agreed to participate in our survey. Of these patients, 8 successfully quit smoking, with 50% quitting before surgery, 25% after discharge, and 25% unable to recall when they quit. The remaining 32 patients surveyed were still current smokers but of these patients 67% were trying to quit. When asked to identify barriers to quitting, patients most frequently cited stress management (59%), habit (59%), being around other smokers (31%) and enjoyment of smoking (31%). 68% of patients recalled having a conversation regarding smoking cessation at some point during the perioperative period. Patients most frequently identified having these conversations with surgeons (44%), nurses (33%), or their primary care physicians (26%) but 41% could not recall who specifically had counseled them. Patients had conversations about smoking cessation with providers in Prepare Clinic (19%), their preoperative surgical visits (27%), a different encounter before surgery (19%), the day of surgery (23%), the post-operative period in the hospital (31%), after discharge (4%), or a different time (35%). When patients were offered a referral to a smoking cessation program, 21% accepted.
Conclusions: The perioperative period poses a great opportunity to approach patients about smoking cessation. While attempts currently happen informally, having a structured system in place would be beneficial. Our data suggests that our current approach may not be generating as much impact as we are hoping as many patients do not recall being approached about smoking cessation around the time of the surgery. At the same time, our survey confirmed that patients were amenable to smoking interventions as many postoperative patients were still interested in quitting smoking and a subset of these patients accepted referrals to other resources for quitting. We hope to use this data to institute changes that will bring about greater access to smoking interventions for patients in the perioperative period at our institution.
