Orthopaedic foot and ankle surgeons’ approach to elective surgery in the smoking patient population: a survey study

Abstract

Background: The changes in healthcare by which physicians may be rewarded or fined based on outcomes compared with national average outcomes give surgeons more incentive to engage patients in practices that will improve results. Smoking cessation has been linked to improvements in surgical outcomes, and the perioperative period may offer the greatest opportunity to achieve cessation. The purpose of this study was to assess the approach of orthopaedic foot and ankle surgeons to smoking patients with foot and ankle conditions. Methods: An e-mail was sent to members of the American Orthopaedic Foot and Ankle Society (AOFAS) with an embedded link to a survey that allowed anonymous responses. Responses were collected during several time points. The survey questions yielded categorical answers that were either dichotomous or multiple choice. Results: Of 1892 possible respondents, 785 participated in the survey, an overall response rate of 41.5%. Some questions had fewer responses dependent on answering yes or no to a previous question. Seven hundred and eight (91.5%) of 774 surgeons reported worse outcomes in smokers; 437 (60.4%) of 724 reported counseling all smoking patients, and 696 (96.5%) of 721 when planning surgery; 616 (79.2%) of 778 would delay or deny surgery based on tobacco use; and 321 (49.5%) of 648 never check systemic nicotine levels preoperatively, 50 (7.7%) always check before surgery, 57 (8.8%) check frequently, and 34% check only rarely or on occasion. Conclusions: Achieving smoking cessation is an important factor in reducing perioperative complications and improving outcomes. Orthopaedic foot and ankle surgeons recognize this and most are likely to delay bony procedures at least 4 wk to allow cessation. Most foot and ankle surgeons counsel their smoking patients to quit before surgery, but many do not use other promising options (such as nicotine replacement and supervised cessation programs) to achieve this goal. Level of Evidence: Level IV, case study.