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June 23, 1997

Smoking Cessation After SurgeryA Randomized Trial

Author Affiliations

From the General Internal Medicine Section, Medical Service (Drs Simon and Browner), and the Psychology Service (Dr Carmody), Department of Veterans Affairs Medical Center, San Francisco, Calif, and the Departments of Epidemiology and Biostatistics (Ms Solkowitz and Drs Simon and Browner), Medicine (Drs Simon and Browner), and Psychiatry (Dr Carmody), University of California, San Francisco.

Arch Intern Med. 1997;157(12):1371-1376. doi:10.1001/archinte.1997.00440330111013

Background:  Cigarette smoking is the greatest cause of preventable mortality in the United States. Because most smokers would like to quit and most hospitals are smoke free, surgical admissions represent a window of opportunity for tobacco cessation interventions.

Methods:  A total of 324 patients (98% men), aged 25 to 82 years, who were current smokers and who underwent noncardiac surgery were enrolled in a randomized controlled trial at the Veterans Affairs Medical Center, San Francisco, Calif. One hundred sixty-eight participants (52%) received a multicomponent intervention designed to increase self-efficacy and coping skills that included face-to-face in-hospital counseling, viewing a smoking cessation videotape, self-help literature, nicotine replacement therapy, and 3 months of telephone follow-up. One hundred fifty-six participants (48%) received self-help literature and brief counseling lasting 10 minutes. Serum or saliva cotinine levels were measured to confirm self-reported smoking cessation.

Results:  At 12 months of follow-up, the self-reported quit rate was 27% among the intervention group and 13% among the comparison group (relative risk, 2.1; 95% confidence interval, 1.2-3.5; P<.01). Based on biochemical confirmation, 15% of the intervention group, compared with 8% of the comparison group, quit smoking at 12 months (relative risk, 2.0; 95% confidence interval, 1.0-3.9; P-.04).

Conclusions:  A smoking cessation intervention targeted at smokers hospitalized for noncardiac surgery can increase long-term quit rates. Surgical hospitalizations provide an opportunity to reach smokers who want to quit smoking.Arch Intern Med. 1997;157:1371-1376