Interventions for preoperative smoking cessation

Abstract

Background: Smokers have a substantially increased risk of intra and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. The preoperative period may be a well chosen time to offer smoking cessation interventions due to increased patient motivation.

Objectives: The objective of this review was to assess the effect of preoperative smoking intervention on smoking cessation in the postoperative period and longer term. We also set out to determine the effect of smoking cessation on the incidence of postoperative complications.

Search strategy: The specialised register of the Tobacco Addiction Group was searched using the free text and keywords (surgery) OR (operation) OR (anaesthesia) or (anesthesia). The databases "EMBASE" and "CINAHL" were also searched, combining tobacco and surgery related terms.

Selection criteria: We considered randomised trials which recruited smokers prior to surgery, offered a smoking cessation intervention, and measured abstinence from smoking in the pre-operative and post-operative periods. We also considered randomised trials of the effect of smoking cessation on the incidence of intra and post-operative complications.

Data collection and analysis: The reviewers independently assessed studies to determine eligibility. The results were discussed between the reviewers.

Main results: No trial meeting the inclusion criteria was found.

Reviewer's conclusions: We found no evidence to determine the effectiveness of pre-operative interventions in helping people to stop smoking, or of the effectiveness of smoking cessation in reducing peri-operative complications. However, observational evidence suggests benefits in stopping smoking before surgery. Although there is no direct evidence about which interventions work best in patients preparing for surgery, behavioural and pharmacological interventions shown to be effective in other settings should be considered.