Smoking cessation in the perioperative period

Stopping smoking really is the best thing anyone can do for their health and to reduce the risk of a bad result after surgery.

The World Health Organization showed that stopping smoking reduces the risk of complications following surgery by 50%.

Stopping smoking improves the blood supply to tissues, so wounds heal better, with fewer infections and lungs work better, with far less need for intensive care. Within hours, the blood is better at carrying oxygen.

Each craving only lasts 90 seconds. The main withdrawal symptoms, such as irritability, are reducing by two weeks. There are many options for help, with psychological support, apps, alternative activities, exercise, nicotine replacement options and websites with personalised coaching.

You can do it!

Supporting patients to stop smoking

Below you will find tools and links to resources to help your patients quit smoking and prepare them for surgery.

Smoking cessation guide - Perioperative Treatment of Tobacco Dependence

Background

Surgical patients who smoke are at higher risk of experiencing complications. These risks are particularly important in surgical populations where smoking prevalence exceeds the background population rate.

Peri-operative care, spanning "from the moment surgery is contemplated through to full recovery" (CPOC) is recognised as a teachable moment wherein there is motivation for spontaneous or health professional-prompted behaviour change.

Evidence from randomised controlled trials indicates that smoking cessation interventions which take place during the perioperative period increase the likelihood that patients will abstain from smoking, both at the time of their operation and one year after surgery. Crucially, such interventions can also reduce perioperative complications.

This guideline aims to offer peri-operative clinicians a structured resource to assist their patients in quitting smoking. It adopts the "Ask, Advice, Act" approach from Very Brief Advice, an evidence-based intervention developed by the National Centre for Smoking Cessation Training (NCSCT) (www.ncsct.co.uk/VBA). It is essential to note that most smoking-related health issues stem from the components of tobacco smoke rather than nicotine itself. The guideline encompasses options for nicotine replacement therapy (NRT) and includes a section on Electronic Nicotine Delivery Systems, commonly know as "vapes" or "e-cigarettes".

Why does perioperative treatment of tobacco dependence matter?

• Stopping smoking greatly reduces perioperative risks.
• The perioperative period presents a 'teachable moment' when:
  • Patients may be motivated to improve their health.
  • There are multiple opportunities to provide information and support.
  • A hospital admission places the patient in a 'no smoking' environment.
• 'Advice from a health professional' is the second most common reason patients give for stopping smoking.
• The more times patients hear these messages, the more likely they are to act on them.
• Smoking is linked to nearly all measure of socio-economic disadvantage. Addressing smoking on surgical waiting lists could improve outcomes for disadvantaged groups.
• There is significant economic burden associated with perioperative smoking.

Infographic: Quit smoking - the perioperative care benefits

Additional smoking cessation resources

Disclaimer 

CPOC has not undertaken a full review of these resources, unless it specifically states CPOC endorsement has been granted. CPOC is simply providing links to these resources.