Can free nicotine replacement therapy (NRT) increase smoking cessation before scheduled surgery?

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Tobacco remains a major cause of death in Australia & NZ, with 20,000 annual deaths. Approximately 300,000 smokers have elective surgery each year in Australia & NZ. Smoking increases anaesthetic and surgical risks; particularly respiratory complications and wound infections. Stopping smoking for >4 weeks before surgery significantly reduces these risks, but there is little data on the best ways to help patients quit before surgery. Many smokers make unassisted quit attempts prior to surgery but relapse is common so most arrive in hospital having smoked that day. The use of nicotine patches and engagement with telephone Quitlines significantly increase quitting success in community settings, but have been little studied in surgical populations. Despite strong evidence in their favour, few smokers having surgery use patches and fewer have Quitline contact. There are no studies looking at using these measures at the time patients go onto the surgical wait-list. More research is important because: (1)Stopping before surgery, especially >4-weeks reduces surgical & anaesthetic complications. (2)There is often a significant period of time on the surgical waiting list to allow such quit times to be achieved (3)Surgery is recognised as a teachable moment for behaviour change; a period in one’s life when there is reflection upon health behaviours and increased motivation for positive change. (4) A significant proportion of patients quitting before surgery remain a lifelong non-smoker. Given the large numbers of smokers having surgery each year, efforts to increase abstinence may be a significant public health benefit. This is health services research to evaluate if an offer of a stop-smoking program will increase quitting before surgery. Smokers of 10 or more cigarettes per day (nicotine dependent) will be offered a free 5-week course of free nicotine patches shortly after they go onto the waiting list. The 5-week nicotine patch supply will be mailed to patients in order to make their use as easy and convenient as possible; eliminating many of the barriers to use. Patients who were smokers at time of waiting list placement will be approached on their day of surgery by a data collector and asked for verbal consent for a short interview (<4-minutes). This will ask if they have quit smoking, or made quit attempts before surgery. For those that claim to have quit (>24 hours), we will ask for written permission to confirm this by exhaled carbon monoxide testing plus to make brief telephone contact at 3 and 6 months after surgery to see if they are still quit. A comparison group of patients who smoke will not have this quit package promoted or offered to them.

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