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Ricker AB, Manning D, Smith KE, Warren YE, Matthews BD, Reinke CE. Preoperative intervention for smoking cessation: A systematic review. Am J Surg 2024; 227:175-182. [PMID: 37865545 DOI: 10.1016/j.amjsurg.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Smoking is associated with increased postoperative complications. Pre-surgical smoking cessation remains a challenge. Our aim was to summarize pre-hospital smoking cessation interventions and impact on smoking cessation rates. METHODS Independent review of English language articles identified from systematic searches of MEDLINE, PubMed, PsycInfo, Embase, Web of Science, and Cumulative Index to Nursing & Allied Health Literature databases from 1998 to 2019 was performed (PROSPERO registration number CRD42021247927). Studies of adult patients enrolled in a pre-hospital smoking cessation intervention were included. Studies with historical controls or only self-reported outcomes were excluded. RESULTS Nine articles including 1762 patients were identified. Exhaled CO was used to confirm cessation. Six studies reported smoking status day of surgery. Interventions included NRT, hand-held technology, e-cigarettes, decision aids/counseling and medications. Four studies demonstrated a difference in smoking cessation rates. Ethics and study appraisal were assessed using ROB2. CONCLUSIONS Based on the variability of interventions, settings, and outcomes, best practice for successful pre-hospital smoking cessation in surgery clinics would benefit from ongoing investigation.
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Affiliation(s)
- Ansley Beth Ricker
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Debra Manning
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Kaylee E Smith
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Yancey E Warren
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Brent D Matthews
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA.
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Prather H, Fogarty AE, Cheng AL, Wahl G, Hong B, Hunt D. Feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions in the setting of lifestyle-related chronic disease. PM R 2023; 15:41-50. [PMID: 34713577 PMCID: PMC9046467 DOI: 10.1002/pmrj.12728] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lifestyle factors are associated with musculoskeletal pain and metabolic chronic diseases. To date, intensive lifestyle medicine programs have predominantly targeted metabolic rather than musculoskeletal conditions. OBJECTIVE To assess the feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions. DESIGN Prospective observational feasibility study. SETTING Tertiary academic medical center. PATIENTS Adults diagnosed with musculoskeletal condition(s) and lifestyle-related chronic disease(s) who previously completed standard-of-care musculoskeletal treatments, enrolled from 2018 to 2020. INTERVENTIONS Patients enrolled in an intensive interprofessional lifestyle medicine program led by a physiatrist, with options to interface with an acupuncturist, dietician, massage therapist, psychologist, physical therapist, and smoking cessation specialist. The physiatrist engaged in shared decision making with patients to establish program goals related to function, overall health, and required lifestyle changes. Bimonthly interprofessional team conferences facilitated communication between treatment team and patients. MAIN OUTCOME MEASURES Feasibility was measured by patient participation and goal attainment. Secondary outcomes included changes from program enrollment to discharge in patient anthropometric, metabolic lab, sleep apnea risk, and Patient-Reported Outcomes Measurement Information System (PROMIS) function, pain, and behavioral health measures. RESULTS Twenty-six patients enrolled in the program (18 [69%] female, mean age 59 [SD 14.5] years, baseline hemoglobin A1c 6.0% [0.8%], high-sensitivity C-reactive protein 7.7 [12.1] mg/dL, 25-hydroxy vitamin D 32.0 [14.2] ng/mL). Of 21 (81%) patients who completed the program, 13/21 (62%) met their goal. On average, program completers presented for 26.2 (10.6) total visits over 191 (88) days. By discharge, program completers achieved clinically meaningful improvement in PROMIS Anxiety (mean difference -3.5 points, 95% confidence interval [-6.5 to 0.5], p = .035), whereas noncompleters did not (p > .05). CONCLUSIONS An intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions is feasible. With training in lifestyle intervention, physiatrists are well suited to lead interprofessional teams aimed at assisting patients in making lifestyle changes to achieve personalized function- and health-related goals.
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Affiliation(s)
- Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, Weill Cornell Medical College, New York, USA
| | - Alexandra E Fogarty
- Department of Neurology, Division of Physical Medicine & Rehabilitation, St. Louis, Missouri, USA
| | - Abby L Cheng
- Departments of Orthopaedic Surgery and Neurology, Division of Physical Medicine and Rehabilitation; Department of Surgery, Division of Public Health Sciences, Chesterfield, Missouri, USA
| | - Garett Wahl
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Barry Hong
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Devyani Hunt
- Departments of Orthopaedic Surgery and Neurology, Division of Physical Medicine and Rehabilitation, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Gunes HY, Caliskan DK, Sakar HA, Yuzkat N. Does smoking affect the onset time of sensory blocks or the duration of motor blocks in parturient women? A randomized controlled trial. Niger J Clin Pract 2022; 25:2039-2045. [PMID: 36537463 DOI: 10.4103/njcp.njcp_527_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND In general, smoking or exposure to secondhand smoke is still common worldwide, and the rate of smoking in women of childbearing age is gradually increasing. Cesarean section rates have been increasing in recent years, and anesthesia guidelines recommend regional anesthesia for cesarean sections. Since nicotine and local anesthetics have different effects on ligand-gated ion channels, smoking may affect spinal anesthesia in pregnant women. Aim: The aim of this study was to investigate the effects of smoking on spinal anesthesia, which is applied for cesarean sections in pregnant women. Patients and. METHODS After approval from the institution's ethics committee, 100 pregnant women were divided into two groups: current smokers (Group S, smoker) (n = 50) and lifelong nonsmokers (Group NS, nonsmoker) (n = 50). The dose of local anesthetic was adjusted according to the height of each patient. After free cerebrospinal fluid flow was observed, all patients were given 20 μμg of fentanyl in 0.05 mg/cm hyperbaric 0.5% bupivacaine within 10 seconds. The onset of sensory and motor block, the duration of sensory and motor block, and the visual analogue scale (VAS) score were monitored. RESULTS Data from 100 parturient women were investigated. Even though the median time required for the onset of sensory block to occur was significantly higher in Group S (P = 0.019), the duration of motor block was found to be shorter (P = 0.003); however, the duration of sensory block was similar in both groups (P = 0.771). VAS scores were significantly higher in Group S (P = 0.001). CONCLUSIONS In conclusion, the pregnant women who smoked had longer motor block onset times, shorter motor block durations, higher VAS scores, and lower patient satisfaction levels.
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Affiliation(s)
- H Y Gunes
- Department of Anesthesiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - D K Caliskan
- Department of Anesthesiology, Van Research and Training Hospital, University of Health Sciences, Van, Turkey
| | - H A Sakar
- Department of Anesthesiology, Van Research and Training Hospital, University of Health Sciences, Van, Turkey
| | - N Yuzkat
- Department of Anesthesiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
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Matthews L, Levett DZH, Grocott MPW. Perioperative Risk Stratification and Modification. Anesthesiol Clin 2022; 40:e1-e23. [PMID: 35595387 DOI: 10.1016/j.anclin.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article discusses the important topic of perioperative risk stratification and the interventions that can be used in the perioperative period for risk modification. It begins with a brief overview of the commonly used scoring systems, risk-prediction models, and assessments of functional capacity and discusses some of the evidence behind each. It then moves on to examine how perioperative risk can be modified through the use of shared decision making, management of multimorbidity, and prehabilitation programs, before considering what the future of risk stratification and modification may hold.
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Affiliation(s)
- Lewis Matthews
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Tremona Road, Southampton SO16 6YD, United Kingdom; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Shackleton Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom.
| | - Denny Z H Levett
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Tremona Road, Southampton SO16 6YD, United Kingdom; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Tremona Road, Southampton SO16 6YD, United Kingdom; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Åsberg K, Bendtsen M. Perioperative digital behaviour change interventions for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation: a scoping review. Perioper Med (Lond) 2021; 10:18. [PMID: 34225795 PMCID: PMC8258960 DOI: 10.1186/s13741-021-00189-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that unhealthy lifestyle behaviours are modifiable risk factors for postoperative complications. Digital behaviour change interventions (DBCIs), for instance text messaging programs and smartphone apps, have shown promise in achieving lifestyle behaviour change in a wide range of clinical populations, and it may therefore be possible to reduce postoperative complications by supporting behaviour change perioperatively using digital interventions. This scoping review was conducted in order to identify existing research done in the area of perioperative DBCIs for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation. MAIN TEXT This scoping review included eleven studies covering a range of surgeries: bariatric, orthopaedic, cancer, transplantation and elective surgery. The studies were both randomised controlled trials and feasibility studies and investigated a diverse set of interventions: one game, three smartphone apps, one web-based program and five text message interventions. Feasibility studies reported user acceptability and satisfaction with the behaviour change support. Engagement data showed participation rates ranged from 40 to 90%, with more participants being actively engaged early in the intervention period. In conclusion, the only full-scale randomised controlled trial (RCT), text messaging ahead of bariatric surgery did not reveal any benefits with respect to adherence to preoperative exercise advice when compared to a control group. Two of the pilot studies, one text message intervention, one game, indicated change in a positive direction with respect to alcohol and tobacco outcomes, but between group comparisons were not done due to small sample sizes. The third pilot-study, a smartphone app, found between group changes for physical activity and alcohol, but not with respect to smoking cessation outcomes. CONCLUSION This review found high participant satisfaction, but shows recruitment and timing-delivery issues, as well as low retention to interventions post-surgery. Small sample sizes and the use of a variety of feasibility outcome measures prevent the synthesis of results and makes generalisation difficult. Future research should focus on defining standardised outcome measures, enhancing patient engagement and improving adherence to behaviour change prior to scheduled surgery.
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Affiliation(s)
- Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden
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Preoperative Cumulative Smoking Dose on Lung Cancer Surgery in a Japanese Nationwide Database. Ann Thorac Surg 2021; 113:237-243. [PMID: 33600791 DOI: 10.1016/j.athoracsur.2021.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Smoking is a known risk factor for postoperative mortality and morbidity. However, the significance of cumulative smoking dose in preoperative risk assessment has not been established. We examined the influence of preoperative cumulative smoking dose on surgical outcomes after lobectomy for primary lung cancer. METHODS A total of 80,989 patients with primary lung cancer undergoing lobectomy from 2014 to 2016 were enrolled. Preoperative cumulative smoking dose was categorized by pack-years (PY): nonsmokers, PY = 0; light smokers, 0 < PY < 10; moderate smokers, 10 ≤ PY < 30; and heavy smokers, 30 ≤ PY. The risk of short-term outcomes was assessed according to PY by multivariable analysis adjusted for other covariates. RESULTS Postoperative 30-day mortality, as well as pulmonary, cardiovascular, and infectious complications, increased with preoperative PY. Multivariable analysis revealed that the odds ratios (ORs) for postoperative mortality compared with nonsmokers were 1.76 for light smokers (P = .044), 1.60 for moderate smokers (P = .026), and 1.73 for heavy smokers (P = .003). The ORs for pulmonary complications compared with nonsmokers were 1.20 for light smokers (P = .022), 1.40 for moderate smokers (P < .001), and 1.72 for heavy smokers (P < .001). Heavy smokers had a significantly increased risk of postoperative cardiovascular (OR, 1.26; P = .002) and infectious (OR, 1.39; P = .007) complications compared with nonsmokers. CONCLUSIONS The risk of mortality and morbidity after lung resection could be predicted according to preoperative cumulative smoking dose. These findings contribute to the development of strategies in perioperative management of lung resection patients.
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Devlin CA, Smeltzer SC. Temporary Perioperative Tobacco Cessation: A Literature Review. AORN J 2017; 106:415-423.e5. [DOI: 10.1016/j.aorn.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/26/2017] [Accepted: 09/01/2017] [Indexed: 01/08/2023]
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Kulkarni K, Karssiens SJ, Massie H, Pandit H. Smoking and orthopaedic surgery: Does the evidence support rationing of care? Musculoskeletal Care 2017; 15:400-404. [PMID: 28078816 DOI: 10.1002/msc.1180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kunal Kulkarni
- Department of Trauma and Orthopaedics, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham, UK
| | - St John Karssiens
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Holly Massie
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Abstract
The majority of patients with Crohn's disease require abdominal surgery during their lifetime, some of whom will require multiple operations. Postoperative complications are seen more frequently in patients requiring abdominal surgery for Crohn's disease than in patients requiring abdominal surgery for other conditions. In this article, we review the evidence supporting preoperative optimization, discussing strategies that potentially improve surgical outcomes and reduce perioperative morbidity and mortality. We discuss the roles of adequate cross-sectional imaging, nutritional optimization, appropriate adjustments of medical therapy, management of preoperative abscesses and phlegmons, smoking cessation and thromboembolic prophylaxis. We also review operation-related factors, and discuss their potential implications with respect to postoperative complications. Overall, the literature suggests that preoperative management has a major effect on postoperative outcomes.
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Warner DO, LeBlanc A, Kadimpati S, Vickers KS, Shi Y, Montori VM. Decision Aid for Cigarette Smokers Scheduled for Elective Surgery. Anesthesiology 2015; 123:18-28. [PMID: 25978327 PMCID: PMC4626302 DOI: 10.1097/aln.0000000000000704] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decision aids can increase patient involvement in decision-making about health care. The study goal was to develop and test a decision aid for use by clinicians in discussion options for changing smoking behavior before and after elective surgery. METHODS In formative work, a decision aid was designed to facilitate patient-clinician discussion regarding three options: continue smoking, attempt a period of temporary abstinence, and attempt to quit smoking for good. A randomized, two-group pilot study was then conducted in smokers evaluated in preparation for elective surgery in a preoperative clinic to test the hypothesis that the decision aid would improve measures of decisional quality compared with usual care. RESULTS The final decision aid consisted of three laminated cards. The front of each card included a colorful graphic describing each choice; the reverse including two to three pros and cons for each decision, a simple graphic illustrating the effects of smoking on the body, and a motivational phrase. In the randomized trial of 130 patients, the decision aid significantly (P < 0.05) improved measures of decisional quality and patient involvement in decision making (Cohen's d effect sizes of 0.76 and 1.20 for the Decisional Conflict Scale and Observing PatienT involvement In decisiON-making scale, respectively). However, the decision aid did not affect any aspect of perioperative smoking behavior, including the distribution of or adherence to choices. CONCLUSIONS Although the use of a decision aid to facilitate clinician-patient discussions regarding tobacco use around the time of surgery substantially improved measures of decisional quality, it alone did not change perioperative tobacco use behavior.
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Affiliation(s)
| | - Annie LeBlanc
- Department of Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | | | | | - Yu Shi
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Victor M. Montori
- Department of Internal Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
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Pluvy I, Panouillères M, Garrido I, Pauchot J, Saboye J, Chavoin J, Tropet Y, Grolleau J, Chaput B. Smoking and plastic surgery, part II. Clinical implications: A systematic review with meta-analysis. ANN CHIR PLAST ESTH 2015; 60:e15-49. [DOI: 10.1016/j.anplas.2014.09.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
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Pluvy I, Garrido I, Pauchot J, Saboye J, Chavoin J, Tropet Y, Grolleau J, Chaput B. Smoking and plastic surgery, part I. Pathophysiological aspects: Update and proposed recommendations. ANN CHIR PLAST ESTH 2015; 60:e3-e13. [DOI: 10.1016/j.anplas.2014.06.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/24/2014] [Indexed: 10/24/2022]
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[Operative risk related to tobacco in gynecology]. ACTA ACUST UNITED AC 2014; 42:343-7. [PMID: 24787606 DOI: 10.1016/j.gyobfe.2014.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/06/2014] [Indexed: 11/23/2022]
Abstract
If tobacco has been recognized for many years as a major risk factor for cardiovascular, lung diseases and cancer in the general population, women are insufficiently aware of the consequences and the specific gynecological operative risks related to this intoxication. Thus, a regular tobacco consumption increases the risk for many gynecological conditions may require surgical treatment with in addition a significant negative impact on the healing process and the risk of postoperative complications. The operative risk must be explained by surgeons in daily practice gynecological, pelvic surgery or breast screening. The issue of smoking cessation should precede surgery has been established by a consensus conference of experts on perioperative smoking held in 2005. The implementation of these recommendations during the preoperative period requires improvement of staff training and better practices to allow smoking cessation effective and sustainable. It is lawful in this context to delay scheduled surgery of 6 to 8 weeks to allow an optimal smoking cessation and to continue smoking cessation for the time necessary for healing to reduce the excess operative risk associated with smoking.
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Impact of smoking on disease phenotype and postoperative outcomes for Crohn's disease patients undergoing surgery. Langenbecks Arch Surg 2011; 398:39-45. [PMID: 22038296 DOI: 10.1007/s00423-011-0865-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 10/10/2011] [Indexed: 10/16/2022]
Abstract
AIM Whether smoking affects disease distribution, phenotype, and perioperative outcomes for Crohn's disease (CD) patients undergoing surgery is not well characterized. The aim of this study is to evaluate the impact of smoking on disease phenotype and postoperative outcomes for CD patients undergoing surgery METHODS Prospectively collected data of CD patients undergoing colorectal resection were evaluated. CD patients who were current smokers (CS) were compared to nonsmokers (NS) and ex-smokers (ES) for disease phenotype, anatomic site involved, procedures performed, postoperative outcomes, and quality of life using the Cleveland Global Quality of Life instrument (CGQL). RESULTS Of 691 patients with a diagnosis of CD requiring surgery 314 were classified as CS, 330 as NS, and 47 as ES. CS and ES in comparison to NS were significantly older at diagnosis of Crohn's disease (mean, 29.3 vs. 29.2 vs. 26.3 years) (P = 0.001) and older at the time of primary surgery (mean, 42.9 vs. 48.4 vs. 39 years) (P = 0.001) with a greater frequency of diabetes. In all groups requiring surgery, there was a significant change in disease phenotype from the time of diagnosis to surgical intervention. The predominant phenotype at diagnosis was inflammatory which changed to stricturing and penetrating as the dominant phenotypes at time of surgery. All groups had a significant improvement in CGQL scores post-surgery with the greatest benefit observed in NS. Postoperative complications and 30-day readmission rates were similar between all groups. CONCLUSIONS The findings of this study show that in patients with CD, disease phenotype changes over time. This occurs independent of smoking. Smoking does not appear to predispose to complications for CD patients undergoing surgery. CS and ES have a persistently reduced quality of life in comparison to NS post-surgery.
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Gourgiotis S, Aloizos S, Aravosita P, Mystakelli C, Isaia EC, Gakis C, Salemis NS. The effects of tobacco smoking on the incidence and risk of intraoperative and postoperative complications in adults. Surgeon 2011; 9:225-32. [DOI: 10.1016/j.surge.2011.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 02/10/2011] [Indexed: 12/26/2022]
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The Gap between Tobacco Treatment Guidelines, Health Service Organization, and Clinical Practice in Comprehensive Cancer Centres. JOURNAL OF ONCOLOGY 2011; 2011:145617. [PMID: 21776269 PMCID: PMC3139132 DOI: 10.1155/2011/145617] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 03/21/2011] [Accepted: 05/13/2011] [Indexed: 12/13/2022]
Abstract
Smoking cessation is necessary to reach a higher quality of life, and, for a cancer patient, it represents an important step in improving the outcome of both prognosis and therapy. Being a cancer patient addicted to nicotine may be a critical situation. We conducted a survey to monitor how many comprehensive cancer centres in Italy have an outpatient smoker clinic and which kinds of resources are available. We also inquired about inpatient services offering psychological and pharmacological support for smoking cessation, reduction, or care of acute nicotine withdrawal symptoms. What we have witnessed is a significant gap between guidelines and services. Oncologists and cancer nurses are overscheduled, with insufficient time to engage in discussion on a problem that they do not consider directly related to cancer treatment. Furthermore, smoking habits and limited training in tobacco dependence and treatment act as an important barrier and lead to the undervaluation of smokers' needs.
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Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med 2011; 124:144-154.e8. [PMID: 21295194 DOI: 10.1016/j.amjmed.2010.09.013] [Citation(s) in RCA: 326] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/09/2010] [Accepted: 09/30/2010] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We aimed to review randomized trials and observational evidence to establish the effect of preoperative smoking cessation on postoperative complications and to determine if there is an optimal cessation period before surgery. METHODS We conducted a systematic review of all randomized trials evaluating the effect of smoking cessation on postoperative complications and all observational studies evaluating the risk of complications among past smokers compared with current smokers. We searched independently, in duplicate, 10 electronic databases and the bibliographies of relevant reviews. We conducted a meta-analysis of randomized trials using a random effects model and performed a meta-regression to examine the impact of time, in weeks, on the magnitude of effect. For observational studies, we pooled proportions of past smokers in comparison with current smokers. RESULTS We included 6 randomized trials and 15 observational studies. We pooled the 6 randomized trials and demonstrated a relative risk reduction of 41% (95% confidence interval [CI], 15-59, P = .01) for prevention of postoperative complications. We found that each week of cessation increases the magnitude of effect by 19%. Trials of at least 4 weeks' smoking cessation had a significantly larger treatment effect than shorter trials (P = .04). Observational studies demonstrated important effects of smoking cessation on decreasing total complications (relative risk [RR] 0.76, 95% CI, 0.69-0.84, P < .0001, I(2) = 15%). This also was observed for reduced wound healing complications (RR 0.73, 95% CI, 0.61-0.87, P = .0006, I(2) = 0%) and pulmonary complications (RR 0.81, 95% CI, 0.70-0.93, P = .003, I(2) = 7%). Observational studies examining duration of cessation demonstrated that longer periods of cessation, compared with shorter periods, had an average reduction in total complications of 20% (RR 0.80, 95% CI, 3-33, P = .02, I(2) = 68%). CONCLUSION Longer periods of smoking cessation decrease the incidence of postoperative complications.
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KJØLHEDE PREBEN, HALILI SHEFQET, LÖFGREN MATS. Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 2010; 90:63-71. [DOI: 10.1111/j.1600-0412.2010.01023.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Mazza R, Lina M, Boffi R, Invernizzi G, De Marco C, Pierotti M. Taking care of smoker cancer patients: a review and some recommendations. Ann Oncol 2010; 21:1404-1409. [DOI: 10.1093/annonc/mdp599] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Eggert E, Schuss R, Edsander-Nord A. Clinical outcome, quality of life, patients' satisfaction, and aesthetic results, after reduction mammaplasty. ACTA ACUST UNITED AC 2009; 43:201-6. [PMID: 19688643 DOI: 10.1080/02844310902891513] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Macromastia is a common indication for breast reduction within the public health care system in Sweden. To reduce the waiting time, a project was launched to operate on patients during a three-month period at a local hospital in Stockholm (Nacka Hospital). The operations were done by specialists and residents from the Karolinska University Hospital, using a medial flap technique. The aim of this prospective study was to evaluate the results of this project, focusing on clinical outcome, quality of life, patients' satisfaction, and aesthetic results. Personal and preoperative clinical data and information about risk factors were extracted from the patients' records. At the 6 month follow-up the patients were asked to fill in two questionnaires: "Short Form-36" and another form about patients' satisfaction and sensitivity. Four digital photos taken during the follow-up were graded by three plastic surgeons. Diabetes and oral contraceptives, respectively, were risk factors for infection and delayed wound healing. Patients reported a significantly increased quality of life after six months, regardless of body mass index. Patients were generally more satisfied with the aesthetic outcome than were the surgeons, had satisfactory aesthetic results (89%), acceptable levels of complications (31%), and increased quality of life. The medial flap technique should be evaluated further for its loss of sensitivity.
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Wolfenden L, Wiggers J, Campbell E, Knight J, Kerridge R, Spigelman A. Providing comprehensive smoking cessation care to surgical patients: the case for computers. Drug Alcohol Rev 2009; 28:60-5. [PMID: 19320677 DOI: 10.1111/j.1465-3362.2008.00003.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS The provision of smoking cessation care to surgical patients before admission can reduce post-operative complications and encourage long-term smoking cessation. Our aim was to show how a comprehensive computer-based smoking cessation intervention, developed to enhance smoking cessation care to surgical patients, addresses barriers to care provision. DESIGN AND METHODS Consultations with preoperative clinic staff and reviews of the scientific literature were conducted and identified the following barriers to the provision of effective smoking cessation care: a lack of organisational support, perceived patient objection, a lack of systems to identify smokers, a lack of staff time and skill, perceived inability to change care practices, a perceived lack of efficacy of cessation care and the cost of providing care. Based on positive findings of a pilot trial, a comprehensive computer-based smoking cessation intervention was implemented in a preoperative clinic. Data from previous evaluations of the intervention were used to assess the extent to which the intervention addressed clinician barriers to care. RESULTS The computer-based intervention was found to provide a means to accurately and systematically identify smokers; it required little clinical staff time or skill; it was considered an acceptable form of care by staff and patients; it was effective in encouraging patient cessation and it was inexpensive to deliver relative to other surgical costs. Furthermore, the computer-based intervention continues to operate in the preoperative clinic in the absence of ongoing research support. DISCUSSION AND CONCLUSIONS The implementation of such a model of care should be considered by clinical services interested in reducing the smoking related morbidity and mortality of patients.
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Affiliation(s)
- Luke Wolfenden
- Hunter New England Population Health, Newcastle, Australia.
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Shourie S, Conigrave KM, Proude EM, Ward JE, Wutzke SE, Haber PS. Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery. Drug Alcohol Rev 2009; 26:119-25. [PMID: 17364846 DOI: 10.1080/09595230601146595] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation.
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Affiliation(s)
- Swati Shourie
- School of Public Health, The University of Sydney, NSW, Australia
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Thomsen T, Tønnesen H, Møller AM. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg 2009; 96:451-61. [DOI: 10.1002/bjs.6591] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
The aim of this study was to examine the effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation itself.
Methods
Relevant databases were searched for randomized controlled trials (RCTs) of preoperative smoking cessation interventions. Trial inclusion, risk of bias assessment and data extraction were performed by two authors. Risk ratios for the above outcomes were calculated and pooled effects estimated using the fixed-effect method.
Results
Eleven RCTs were included containing 1194 patients. Smoking interventions were intensive, medium intensity and less intensive. Follow-up for postoperative complications was 30 days. For smoking cessation it was from the day of surgery to 12 months thereafter. Overall, the interventions significantly reduced the occurrence of complications (pooled risk ratio 0·56 (95 per cent confidence interval 0·41 to 0·78); P < 0·001). Intensive interventions increased smoking cessation rates both before operation and up to 12 months thereafter. The effects of medium to less intensive interventions were not significant. Meta-analysis of the effect on smoking cessation was not done owing to heterogeneity of data.
Conclusion
Surgical patients may benefit from intensive preoperative smoking cessation interventions. These include individual counselling initiated at least 4 weeks before operation and nicotine replacement therapy.
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Affiliation(s)
- T Thomsen
- Research and Development Unit, Department of Anaesthesiology, Herlev University Hospital, Herlev, Denmark
| | - H Tønnesen
- Clinical Unit of Health Promotion/World Health Organization Collaborating Centre for Evidence-Based Health Promotion, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A M Møller
- Research and Development Unit, Department of Anaesthesiology, Herlev University Hospital, Herlev, Denmark
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Barrow C. A patient's journey through the operating department from an infection control perspective. J Perioper Pract 2009; 19:94-98. [PMID: 19397060 DOI: 10.1177/175045890901900302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The path a patient negotiates through an operating department is shaped by its design and layout, which should be determined by infection control requirements to ensure the safety of both patients and practitioners. How this is achieved is discussed in relation to an operating department in a local trust, together with how infection control, and therefore the prevention of surgical site infection, is achieved through hospital policies and key practices within a theatre by theatre practitioners and surgeons.
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Affiliation(s)
- Claire Barrow
- AfPP, Daisy Ayris House, 6 Grove Park Court, Harrogate, HG1 4DP.
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Vazirani S, Paige NM, Nouvong A, Aungst D. Evaluating and minimizing cardiac risk in surgical patients. Clin Podiatr Med Surg 2007; 24:261-83. [PMID: 17430770 DOI: 10.1016/j.cpm.2006.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular complications are a major cause of postoperative morbidity and mortality. Proper assessment of risk and subsequent interventions can help diminish these complications. Assessing the patient's risk is based on the type of surgery performed and on individual patient characteristics. The latter can be established with a thorough history and physical, laboratory testing, risk indices, and cardiology studies.
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Affiliation(s)
- Sondra Vazirani
- Department of Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine-UCLA, 11301 Wilshire Boulevard, 10H1/111, Los Angeles, CA 90073, USA.
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Bullen C, Whittaker R, McRobbie H, Fagerström K. A Clinical Imperative: Assisting Patients Who Smoke to Reduce Their Risk of Cardiovascular Disease. ACTA ACUST UNITED AC 2007; 10:5-9. [PMID: 17396062 DOI: 10.1111/j.1520-037x.2007.06525.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of tobacco smoking as a cause of cardiovascular disease is now unequivocal and well-documented in literally hundreds of epidemiologic and biomedical studies over the past 50 years. Cessation of smoking, on the other hand, swiftly and profoundly reduces the risks of a cardiovascular event. Thus, smoking cessation should be seen as perhaps the most effective lifesaving intervention in the physician's armamentarium. Despite this widely available knowledge, and evidence that most smokers want to quit, relatively few physicians offer cessation support to their smoking patients, even those at high risk for a cardiovascular event. This article reviews the links between tobacco smoking and cardiovascular disease, argues for a greater role for physicians in assisting smokers to quit, and highlights the most effective interventions currently available.
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Affiliation(s)
- Chris Bullen
- Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand.
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