Smoking cessation in elective surgical patients offered free nicotine patches at listing: a pilot study

• Published in: Anaesthesia Vol. 75; no. 2; pp. 171 - 178
• Main Authors: Webb, A. R., Coward, L., Soh, L., Waugh, L., Parsons, L., Lynch, M., Stokan, L.‐A., Borland, R.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.02.2020
• Subjects: Anesthesia; Carbon monoxide; Cigarette smoking; Cigarettes; Drug addiction; elective surgery; Elective Surgical Procedures; Feasibility Studies; Female; Humans; Male; Middle Aged; Nicotine; nicotine replacement therapy; Patches (structures); Pilot Projects; prehabilitation; Preoperative Care - methods; Prospective Studies; Smoking; Smoking - therapy; Smoking cessation; Smoking Cessation - methods; Smoking Cessation - statistics & numerical data; Surgery; tobacco control; Tobacco Use Cessation Devices; Transdermal medication; Treatment Outcome; elective surgery; prehabilitation; nicotine replacement therapy; smoking cessation; tobacco control
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.14863

Summary Free nicotine patches may promote pre‐operative smoking cessation. Smokers (≥ 10 cigarettes.day−1) awaiting non‐urgent surgery were randomly assigned (3:1) to an offer of free nicotine patches or a control group who were not offered free nicotine patches. The suggested regimen lasted 5 weeks, with patch strength decreasing incrementally after 3 and 4 weeks. The primary outcome was smoking abstinence for ≥ 4 weeks, as self‐reported by participants on the day of surgery, including, where possible, corroboration using exhaled carbon monoxide testing. Out of 600 included smokers, 447 (74.5%) were randomly assigned to an offer of pre‐operative nicotine patches, with 175 (39.1%) of these accepting the offer and 56 (12.5%) using patches for ≥ 3 weeks. Out of 396 participants offered nicotine patches who were included for analysis, 36 (9.1%) quit smoking for ≥ 4 weeks before surgery as compared with 8 (5.9%) controls, OR 1.5 [95%CI 0.7–3.2], p = 0.300. Sixty‐three (15.9%) quit smoking for 24 h before surgery as compared with 15 (11.1%) controls, OR 1.4 [95%CI 0.8–2.4], p = 0.200. Participants offered nicotine patches were more likely to engage in a cessation attempt lasting more than 24 h, 46 (11.6%) vs. 5 (3.7%), OR 3.4 [95%CI 1.8–8.8], p = 0.010. Out of 78 participants who quit smoking by the day of surgery and were followed up at 6 months, 46 (59%) had relapsed. Offering free nicotine patches stimulated interest in quitting compared with controls, but our protocol had limited effectiveness.