Smoking intervention program before surgery reduces post-op morbidity

By Karla Gale

NEW YORK (Reuters Health) – Involving patients in an effective smoking intervention program 6 to 8 weeks before surgery results in fewer complications, investigators in Copenhagen report.

In a randomized trial reported in the January 12th issue of The Lancet, patients undergoing primary elective hip or knee alloplasty and assigned to the intervention group were counseled weekly and given nicotine replacement. The control group received little or no information about the risk of smoking.

According to Dr. Ann M. Moller and associates, of Bispebjerg University Hospital, 56 patients in the intervention group completed the study, including 36 who stopped smoking completely, 14 who reduced their smoking by at least 50%, and six who continued to smoke. Among the 52 patients in the control group, four stopped smoking.

There were significantly more complications among those in the control group compared with the intervention group. For example, three in the intervention group and 16 in the control group suffered wound-related complications, including infection in two and 12 patients, respectively. Five patients in the control group, but none in other group, experienced cardiovascular insufficiency.

Two intervention patients versus eight control patients required secondary surgery. Dr. Moller noted in an interview with Reuters Health that some of these were wound revisions, which are not necessarily "big procedures," but that some involved loosening of the prosthesis.

Control patients spent on average of 2 extra days in the orthopedic department, and a median of 32 days in intensive care, while those in the smoking cessation program spent a median of 2 days in intensive care.

"It's extremely important when trying to implement a similar program that patients receive psychological support and nicotine therapy," Dr. Moller emphasized. Otherwise, she said, the likelihood of successful smoking cessation is low.

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