Complications are a major concern after elective surgery and smokers have an increased risk.
There is insufficient evidence concerning how the duration of preoperative smoking intervention affects postoperative complications.
Dr David Lindstrom and colleagues from Sweden determined whether an intervention with smoking cessation starting 4 weeks before general and orthopedic surgery would reduce the frequency of postoperative complications.
The team conducted a randomized controlled trial at 4 university-affiliated hospitals in the Stockholm region, Sweden between 2004 and 2006.
|Overall complications rates in the intervention group was 21%|
|Annals of Surgery |
The outcome assessment was blinded.
The follow-up period for the primary outcome was 30 days.
Eligibility criteria were active daily smokers, aged 18 to 79 years.
Of the 238 patients assessed, 76 refused participating.
The research team enrolled 117 men and women undergoing surgery for primary hernia repair, laparoscopic cholecystectomy, or a hip or knee prosthesis.
Smoking cessation therapy with individual counseling and nicotine substitution started 4 weeks before surgery and continued 4 weeks postoperatively.
The control group received standard care.
The main outcome measure was frequency of any postoperative complication.
The researchers used intention-to-treat analysis to show that the overall complication rate in the control group was 41%, and 21% in the intervention group.
The team noted that the relative risk reduction for the primary outcome of any postoperative complication was 49%, and number needed to treat was 5.
An analysis per protocol showed that abstainers had fewer complications than those who continued to smoke or only reduced smoking, although this difference was not significant.
Dr Lindstrom’s team concluded, “Perioperative smoking cessation seems to be an effective tool to reduce postoperative complications even if it is introduced as late as 4 weeks before surgery.”