Abstract
Objective: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce.Design: This was a retrospective cohort study.Setting: The Stop Smoking before Surgery Project (SSSP) started in Porvoo, Finland, in May of 2016, involving both primary health care and specialized health care. The goals of the project were smoking awareness and preoperative smoking cessation.Subjects: Our study involved 1482 surgical patients operated at Porvoo Hospital between May and December of 2016.Main outcome measures: We studied the recording of smoking status in all patients, and ICD-10 diagnosis of nicotine dependency and the initiation of preoperative smoking cessation in current smokers. Variables were studied from electronic patient records, comparing primary health care referrals and surgical outpatient clinic records.Results: Smoking status was visible in 14.2% of primary health care referrals, and in 18.4% of outpatient clinic records. Corresponding rates for current smokers (n = 275) were 0.0 and 8.7% for ICD-10 diagnosis of nicotine dependence, and 2.2 and 15.3% for initiation of preoperative smoking cessation. The differences between primary health care referrals and outpatient clinic records were statistically significant for all three variables (p ≤ .001).Conclusion: In primary health care, very little attention was paid to preoperative smoking cessation. Rates were significantly better at the surgical outpatient clinic, but still low. We could not demonstrate any certain effect of the intervention. Our results call for future research on ways to improve smoking cessation rates.Key pointsTobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce.We found weak smoking awareness and weak smoking cessation intervention numbers among both primary and specialized health care doctors. Our results indicate an urgent need for an efficient preoperative smoking cessation model involving both primary and specialized health care.
Highlights
Smoking is a major cause of morbidity and mortality, and a significant economic burden both in developed and in developing countries
We studied the recording of smoking status concerning the whole study population, and ICD-10 ND and the initiation of preoperative smoking cessation concerning current smokers
When comparing the primary health care referrals (PCRs) made before April 1st 2016 with those made after October 1st 2016, we found no improvement in smoking status (14% and 9%), ICD-10 ND recording (0% and 0%), or smoking cessation initiation (0% and 0%)
Summary
Smoking is a major cause of morbidity and mortality, and a significant economic burden both in developed and in developing countries. Large cohort studies on major surgical procedures have demonstrated the increased risk of postoperative complications caused by smoking. They have confirmed higher mortality, and increased risk of cardiac, arterial and pulmonary events and infections among smokers compared to nonsmokers [2,3,4]. The probability of quitting smoking is especially high in major surgical procedures, and noteworthy in outpatient procedures [5]. The preoperative time frame is usually sufficiently long for smoking cessation in time to provide positive effects regarding postoperative complications. The ideal time frame for quitting is still under debate [6]
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