Preoperative Smoking Cessation

Abstract

Habitual tobacco use is the leading preventable cause of death in the United States and is responsible for 1 of every 5 deaths. Although there has been a steady decline in the percentage of smokers since 1960, a plateau in this progress has been noted in the past decade. In 2000, 25.7% of males and 21.0% of females were smokers. The physiologic impact of smoking is well described and includes impaired mucus transport and pulmonary macrophage function, increased bronchial reactivity and arterial carbon monoxide levels, reduced oxygen transport, and inhibited mitochondrial oxidative metabolism. In addition, active smoking, including heavy ( 20 cigarettes/d) and lighter users, has also been associated with an increased relative risk (1.44 overall) of the future development of type 2 diabetes mellitus. Attempts at smoking cessation are most successful in highly motivated individuals; however, even within established tobacco cessation programs, long-term abstinence rates are often low. In a study by Anthonisen et al, patients were involved in a 10week smoking cessation program that included physician input, 12 group meetings with behavioral modification, and nicotine gum. At 5 years, 21.7% of the intervention participants had stopped smoking. Only 5.4%of thecontrol grouphadstopped smoking during that same period. Not surprisingly, the death rates for both lung cancer and cardiovascular disease were noted to be significantly lower in the intervention group when compared with controls. The number of studies within the field of otolaryngology–head and neck surgery examining the impact of smoking cessation on surgery are limited. The question this article will explore is whether a short-term period of preoperative smoking cessation has an effect on the perioperative and postoperative results in head and neck surgery. The treatment of head and neck cancer requires that surgery be performed within a reasonable period of time after the establishment of diagnosis. As a result, it is not always possible to allow for extended periods of time to be dedicated to programs specifically addressing alcohol and tobacco dependence. Although not focused exclusively on head and neck cancer, a review of the literature concerning the surgical experience with preoperative smoking cessation can provide insight relative to this topic.