Prevalence of patients continuing to smoke after vascular interventions

Nicotine Dependence and the Level of Motivation for Ceasing Smoking in the Case of Patients Undergoing Vascular Surgeries Versus the Optimisation of Perioperative Care-Pilot Survey

INTRODUCTION

Smoking is one of key risk factors of cardiovascular diseases, including abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), and carotid artery disease (CAD). Despite attempts being made to make the society aware of the consequences of passive and active smoking, as well as worldwide and nationwide epidemiologic research reflecting the scale of the problem, there are still a lot of smokers.

AIM

The purpose of the study was to assess the relationship between the degree of addiction and the level of motivation for ceasing smoking in the case of patients before vascular surgery. Furthermore, to point out factors that have a significant impact on the level of nicotine dependence and motivation for ceasing smoking.

METHODS

The survey included patients qualified for vascular surgeries. The patients were active smokers: 69.3% men and 30.7% women. The survey was conducted in the form of a questionnaire based on standard research tools: the Fagerström Test for Nicotine Dependence (FTND), the Test of Motivation for Ceasing Smoking by Nina Schneider, and the original questionnaire aimed at collecting social and demographic data.

RESULTS

Most patients showed a high or moderate degree of nicotine dependence: 46.5% and 40.6%, respectively. An average nicotine dependence ratio based on the Fagerström test was 6.23 ± 2.39. An average motivation for the ceasing smoking ratio was 4.88 ± 2.76. Only 34.7% of the patients had a high motivation for ceasing smoking. Over half of the patients (61.4%) attempted to cease smoking in the past.

CONCLUSIONS

Most patients undergoing vascular surgeries showed a high or moderate degree of nicotine dependence and low motivation to quit smoking. The greater the addiction to nicotine, the lower the motivation to quit smoking. Social and demographic factors do not affect the degree of nicotine addiction and the motivation to quit smoking. Years of smoking had an impact on the incidence of chronic obstructive pulmonary disease (COPD).

Utilization of the Electronic Health Record to Improve Provision of Smoking Cessation Resources for Vascular Surgery Inpatients

BACKGROUND AND OBJECTIVES

Identification of hospitalized patients who smoke has shown significant improvement in recent years, but provision of evidence-based tobacco cessation treatment remains a challenge. This study evaluated the utilization of an electronic health record (EHR) to facilitate implementation of evidence-based clinical practice guidelines for smoking cessation on a vascular surgery inpatient unit.

METHODS

A pre-and post-intervention cohort study was conducted over 6 months at a single academic medical center with a comprehensive EHR. All patients admitted to the vascular surgery service and documented as current smokers were included. A vascular surgery discharge order set with an evidence-based smoking cessation module was developed and implemented. The primary outcome was prescription of nicotine replacement therapy (NRT) at the time of discharge. The secondary outcome was referral for smoking cessation counseling at the time of discharge.

RESULTS

There were 52 and 42 smokers in the pre-and post-intervention cohorts, respectively. Over the 3 months following implementation of the EHR order set, prescription of NRT at the time of discharge did not change significantly (27% vs 19%, p=0.30). Referral for outpatient smoking cessation counseling increased in the post-intervention group, but did not reach significance (64% vs 72%, p=0.20).

CONCLUSIONS

Implementation of a brief tobacco dependence treatment order set in an existing EHR increased cessation counseling referrals on a vascular surgery inpatient unit. One potential limitation of the study was the modest sample size. Not being able to make smoking cessation treatment a mandatory component in discharge orders may also have contributed to the modest effect. Assessing the differential effect of EHR-based order implementation will be important in future research on this topic.

Tobacco dependence in surgical patients

PURPOSE OF REVIEW

Many patients who smoke cigarettes require anesthesia and surgery. Their smoking can have profound consequences for perioperative management. Efforts to help them quit will be rewarded by both improved immediate postoperative outcomes and the long-term health benefits after surgery. This review will introduce basic concepts important to perioperative tobacco control and cover recent advances in the field.

RECENT FINDINGS

Evidence continues to accumulate regarding how smoking increases perioperative risk, especially of wound-related complications. There is also new information regarding how abstinence from smoking reduces risk, including how the timing of preoperative abstinence affects outcome. Methods to help surgical patients continue to be developed, taking advantage of surgery as a teachable moment for intervention. There is a need to develop methods practical in the surgical setting. Several pharmacological tools to help surgical patients quit smoking are available, including a new partial acetylcholine receptor agonist.

SUMMARY

The fact that the perioperative period represents an excellent opportunity to help surgical patients quit smoking is becoming increasingly apparent. Although these efforts, and the evidence base to support them, are still at an early stage of development, seizing this opportunity will benefit both the short and long-term health of our patients who smoke.