Engagement and Effectiveness of a Smoking Cessation Quitline Intervention in a Thoracic Surgery Clinic | Cardiothoracic Surgery | JAMA Surgery | JAMA Network
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    Original Investigation
    July 1, 2020

    Engagement and Effectiveness of a Smoking Cessation Quitline Intervention in a Thoracic Surgery Clinic

    Author Affiliations
    • 1Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento
    • 2Department of Internal Medicine, University of California, Davis Health, Sacramento
    • 3University of California Davis Comprehensive Cancer Center, Sacramento
    JAMA Surg. 2020;155(9):816-822. doi:10.1001/jamasurg.2020.1915
    Key Points

    Question  What factors are associated with a higher level of engagement and smoking cessation outcomes among patients in a thoracic surgery clinic who agreed to participate in a smoking quitline intervention?

    Findings  Although the level of quitline engagement in this cohort study was similar between patients who underwent surgery (55%) and those who did not undergo surgery (45%), those undergoing surgery were nearly twice as likely (64% vs 36%) to quit smoking regardless of quitline participation. Patients undergoing surgery who engaged in the quitline had a 1.8-fold higher odds of point prevalence abstinence at 6 months than those who did not.

    Meaning  Patients undergoing a thoracic operation are motivated to quit smoking, and quitline engagement amplifies long-term abstinence.


    Importance  Smoking quitline programs effectively promote smoking cessation in outpatient primary care settings.

    Objective  To examine the factors associated with smoking quitline engagement and smoking cessation among patients undergoing thoracic surgery who consented to a quitline electronic referral.

    Design, Setting, and Participants  A retrospective cohort study was conducted from January 1, 2014, to December 31, 2018, among 111 active smoking patients referred to the quitline from a thoracic surgery outpatient clinic visit. Patients were divided into operative and nonoperative cohorts.

    Main Outcomes and Measures  Primary outcomes were engagement rates in the quitline program and successful smoking cessation. Secondary outcomes were self-reported point prevalence abstinence at 1 month and 6 months after the smoking quit date.

    Results  Of 111 patients (62 men; mean [SD] age, 61.8 [11.2] years) who had a quitline referral, 58 (52%) underwent surgery, and 32 of these 58 patients (55%) participated in the program. Of the 53 nonoperative patients (48%), 24 (45%) participated in the program. In the operative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (21 of 32 [66%] vs 16 of 6 [62%]; P = .79) or in point prevalence abstinence at 1 month (23 of 32 [72%] vs 14 of 25 [56%]; P = .27) or 6 months (14 of 28 [50%] vs 6 of 18 [33%]; P = .36). Similarly, in the nonoperative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (8 of 24 [33%] vs 11 of 29 [38%]; P = .78) or in point prevalence abstinence at 1 month (7 of 24 [29%] vs 8 of 27 [30%]; P = .99) or 6 months (6 of 23 [26%] vs 6 of 25 [24%]; P = .99). Regardless of quitline participation, operative patients had a 1.8-fold higher proportion of successful smoking cessation compared with nonoperative patients (37 of 58 [64%] vs 19 of 53 [36%]; P = .004) as well as a 2.2-fold higher proportion of 1-month point prevalence abstinence (37 of 57 [65%] vs 15 of 51 [29%]; P < .001) and a 1.8-fold higher proportion of 6-month point prevalence abstinence (20 of 45 [44%] vs 12 of 48 [25%]; P = .05). Having surgery doubled the odds of smoking cessation (odds ratio, 2.44; 95% CI, 1.06-5.64; P = .04) and quitline engagement tripled the odds of remaining smoke free at 6 months (odds ratio, 3.57; 95% CI, 1.03-12.38; P = .04).

    Conclusions and Relevance  Patients undergoing thoracic surgery were nearly twice as likely to quit smoking as those who did not have an operation, and smoking quitline participation further augmented point prevalence abstinence. Improved smoking cessation rates, even among nonoperative patients, were associated with appropriate outpatient counseling and intervention.