Interventions for preoperative smoking cessation

 

Abstract

Background

Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions.

Objectives

The objective of this review was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications.

Search methods

The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text and keywords (surgery) or (operation) or (anaesthesia) or (anesthesia). MEDLINE, EMBASE and CINAHL were also searched, combining tobacco- and surgery-related terms. Most recent search April 2010.

Selection criteria

Randomized controlled trials that recruited people who smoked prior to surgery, offered a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking and/or the incidence of postoperative complications.

Data collection and analysis

The authors independently assessed studies to determine eligibility. Results were discussed between the authors.

Main results

Eight trials enrolling a total of 1156 people met the inclusion criteria. One of these did not report cessation as an outcome. Two trials initiated multisession face to face counselling at least 6 weeks before surgery whilst six used a brief intervention. Nicotine replacement therapy (NRT) was offered or recommended to some or all participants in seven trials. Five trials detected significantly increased smoking cessation at the time of surgery, and one approached significance. Subgroup analyses showed that both intensive and brief intervention significantly increased smoking cessation at the time of surgery; pooled RR 10.76 (95% confidence interval (CI) 4.55 to 25.46, two trials) and RR 1.41 (95% CI 1.22 to 1.63, five trials) respectively. Four trials evaluating the effect on long-term smoking cessation found a significant effect; pooled RR 1.61 (95% CI 1.12 to 2.33). However, when pooling intensive and brief interventions separately, only intensive intervention retained a significant effect on long-term smoking cessation; RR 2.96 (95% CI 1.57 to 5.55, two trials).

Five trials examined the effect of smoking intervention on postoperative complications. Pooled risk ratios were 0.70 (95% CI 0.56 to 0.88) for developing any complication; and 0.70 (95% CI 0.51 to 0.95) for wound complications. Exploratory subgroup analyses showed a significant effect of intensive intervention on any complications; RR 0.42 (95% CI 0.27 to 0.65) and on wound complications RR 0.31 (95% CI 0.16 to 0.62). For brief interventions the effect was not statistically significant but CIs do not rule out a clinically significant effect (RR 0.96 (95% CI 0.74 to 1.25) for any complication, RR 0.99 (95% CI 0.70 to 1.40) for wound complications).

Authors' conclusions

There is evidence that preoperative smoking interventions including NRT increase short-term smoking cessation and may reduce postoperative morbidity. The optimal preoperative intervention intensity remains unknown. Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling, and use NRT are more likely to have an impact on complications and on long-term smoking cessation.

 

Plain language summary

Can people be helped to stop smoking before they have surgery?

Smoking is a well-known risk factor for complications after surgery. Studies of interventions to encourage smokers to stop smoking before their operation show that short- and long-term quitting can be achieved. Evidence from two small trials indicates that interventions that begin four to eight weeks before surgery, which include weekly counselling and use NRT, support smoking cessation and may reduce complication rates. Brief interventions support short-term smoking cessation but there is insufficient evidence from this review to determine whether they reduce complications. This may be due to the longer period of pre-operative abstinence that can be achieved when interventions begin four to eight weeks before surgery.

 

摘要

背景

手術前戒菸處遇

吸菸者有大幅增加手術內與手術後併發症的風險。手術前吸菸處遇能有效地降低這樣的風險。在手術前提供戒菸處遇，是一個提昇患者戒菸動機，供患者選擇的絕佳時刻

目標

吸菸者有大幅增加手術內與手術後併發症的風險。手術前吸菸處遇能有效地降低這樣的風險。在手術前提供戒菸處遇，是一個提昇患者戒菸動機，供患者選擇的絕佳時刻

搜尋策略

專門登記在Cochrane Tobacco Addiction Group，以隨意的文字或關鍵字((surgery)或(operation)或(anaesthesia)或(anesthesia)搜尋。也搜尋了MEDLINE，EMBASE和CINAHL，結合吸菸和手術相關的詞語。最近搜索至2005年2月

選擇標準

我們採用在術前招募的吸煙者，提供戒菸處遇，以及評估在術前及術後禁菸狀況的隨機取樣研究。我們也採用了戒菸對發生術中與術後併發症的影響的隨機取樣研究

資料收集與分析

作者獨自評估研究的適切性，評估結果由作者們一起討論決定

主要結論

4個研究符合納入標準。所有研究在減少術前抽菸方面是達顯著的，但效果量的異質性高，所以集中效果並沒有估計。只有兩個研究結果戒菸處遇在傷口併發上有影響，結果的異質性高，在一個研究上顯示在與傷口有關的併發症、心血管併發症，及其他併發症的整體風險上有明顯的減少，在另一個研究上則沒有證據顯示在併發症有明顯的差異。在兩個以手術的住院期間及後續的追蹤研究上，顯示長期的戒菸率方面沒有顯著的效果

作者結論

術前吸菸的處遇對手術住院期間改變吸煙行為上是有效的。在兩個小研究的不同結果上，有直接的證據顯示減少或停止吸菸減少了術後併發症的風險。併發症的衝擊可能是取決於手術前改變吸菸的習慣有多久，吸菸量是否減少或完全不吸菸，以及手術的類型

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

吸菸者會增加手術後併發症的風險，但有限直接證據顯示，在手術前停止吸菸會減少併發症。眾所周知吸菸是手術後併發症的風險因子。處遇的研究鼓勵癮君子在手術前停止吸菸，短暫的戒菸或減少抽菸是可以辦到的。處遇對於術後併發症上的效果並不清楚，可能取決於手術前改變吸菸的習慣有多久