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Preoperative pharmacologic smoking cessation interventions for elective surgical patients

Preoperative pharmacologic smoking cessation interventions for elective-surgical patients (6).

Intervention summary: 

One moderate quality study (6) compared the effectiveness of a smoking cessation intervention with varenicline medication to placebo for both short-term (immediately before surgery, 3- and 6-months after surgery) and long-term (12-months after surgery) abstinence, in patients awaiting a wide range of elective surgeries. 

The elective surgical patients were enrolled from surgical services including ambulatory or inpatient general surgery, ophthalmology, orthopaedic, neurosurgical, plastics, obstetrics/gynaecology and urology. In both groups the treatment (placebo or varenicline) commenced one week before surgery, and continued post-operatively.Additionally, both groups also received two sessions of standardised counselling with the first session delivered before surgery and the second delivered either 24hrs after surgery or before discharge.

The evidence of effectiveness of preoperative pharmacologic smoking cessation interventions for elective surgical patients is lacking for the following outcomes:

Abstinence- 24hr before surgery:

Might not be effective (1 moderate quality study showing no effect for the intervention when compared to control) (6).

Abstinence- 3 months after surgery:

Might be effective (1 moderate quality study showing a significant effect for intervention when compared to control) (6).

Abstinence- 6 months after surgery:

Might be effective (1 moderate quality study a showing significant effect for intervention when compared to control) (6).

Abstinence- 12 months after surgery:

Might be effective (1 moderate quality study showing a significant effect for intervention when compared to control) (6).

Number of cigarettes/day preoperatively:

Might not be effective (1 moderate quality study showing no effect for intervention when compared to control) (6).

Number of cigarettes/day 3 months after surgery:

Might not be effective (1 moderate quality study showing no effect for intervention when compared to control) (6).

Number of cigarettes/day 6 months after surgery:

Might not be effective (1 moderate quality study showing no effect for intervention when compared to control) (6).

Number of cigarettes/day 12 months after surgery:

Might not be effective (1 moderate quality study showing no effect for intervention when compared to control) (6).

Severe adverse events including unanticipated hospital admissions:

Might not be effective (1 moderate quality study showing significantly higher reported severe adverse events including unanticipated hospital admissions compared to the control group) (6).

Surgical and postoperative complications:

Might be effective (1 moderate quality study showing no effect for intervention when compared to control) (6).