E-cigarettes versus nicotine patches for perioperative smoking cessation: a pilot randomized trial

Abstract

Introduction: Cigarette smoking by surgical patients is associated with increased complications. E-cigarettes have emerged as a potential smoking cessation tool. We sought to determine the feasibility and acceptability of e-cigarettes, compared to nicotine patch, for perioperative smoking cessation in veterans.

Methods: Preoperative patients were randomized to either the nicotine patch group (n = 10) or the e-cigarette group (n = 20). Both groups were given a free 6-week supply in a tapering dose. All patients received brief counseling, a brochure on perioperative smoking cessation, and referral to the California Smokers' Helpline. The primary outcome was rate of smoking cessation on day of surgery confirmed by exhaled carbon monoxide. Secondary outcomes included smoking habits, pulmonary function, adverse events, and satisfaction with the products on day of surgery and at 8-weeks follow-up.

Results: Biochemically verified smoking cessation on day of surgery was similar in both groups. Change in forced expiratory volume in one second (FEV1) was 592 ml greater in the e-cigarette group (95% CI [153-1,031] ml, p = 0.01) and change in forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC ratio) was 40.1% greater in the e-cigarette group (95% CI [18.2%-78.4%], p = 0.04). Satisfaction with the product was similar in both groups.

Discussion: E-cigarettes are a feasible tool for perioperative smoking cessation in veterans with quit rates comparable to nicotine replacement patch. Spirometry appears to be improved 8-weeks after initiating e-cigarettes compared to nicotine patch, possibly due to worse baseline spirometry and more smoking reduction in the e-cigarette group. An adequately powered study is recommended to determine if these results can be duplicated.

Keywords: Electronic cigarette; Electronic nicotine delivery device; Nicotine replacement therapy; Perioperative; Pilot study; Quit smoking; Randomized controlled trial; Smoking cessation; Tobacco cessation; e-cigarette.

Figure 1. Consolidated Standards of Reporting Trials flow chart indicating recruitment, randomization and retention of trial participants.

Of the 35 patients approached for inclusion but found to be ineligible, the reasons for ineligibility included: smoking less than two cigarettes per day (n = 10), already being on smoking cessation pharmacotherapy (n = 9), smoking non-cigarette tobacco only (n = 5), prior adverse reaction to NRT patch (n = 3), already enrolled in smoking cessation program (n = 3), regular use of e-cigarettes (n = 2), surgical date changed (n = 2) and currently experiencing an unstable cardiac condition (n = 1). One patient was found to be ineligible after consent, but prior to randomization. All patients were given the treatment (END or NRT) to which they were randomized. Losses to follow-up were minimal and balanced between groups.