Stopping smoking shortly before surgery and postoperative complications: a systematic review and meta-analysis.
ABSTRACT To examine existing smoking studies that compare surgical patients who have recently quit smoking with those who continue to smoke to provide an evidence-based recommendation for front-line staff. Concerns have been expressed that stopping smoking within 8 weeks before surgery may be detrimental to postoperative outcomes. This has generated considerable uncertainty even in health care systems that consider smoking cessation advice in the hospital setting an important priority. Smokers who stop smoking shortly before surgery (recent quitters) have been reported to have worse surgical outcomes than early quitters, but this may indicate only that recent quitting is less beneficial than early quitting, not that it is risky.
Systematic review with meta-analysis.
British Nursing Index (BNI), The Cochrane Library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, PsycINFO to May 2010, and reference lists of included studies.
Studies were included that allow a comparison of postoperative complications in patients undergoing any type of surgery who stopped smoking within 8 weeks prior to surgery and those who continued to smoke.
Two reviewers independently screened potential studies and assessed their methodologic quality. Data were entered into 3 separate meta-analyses that considered all available studies, studies with a low risk of bias that validated self-reported abstinence (to assess possible benefits), and studies of pulmonary complications only (to assess possible risks). Results were combined by using a random-effects model, and heterogeneity was evaluated by using the I(2) statistic.
Nine studies met the inclusion criteria. One found a beneficial effect of recent quitting compared with continuing smoking, and none identified any detrimental effects. In meta-analyses, quitting smoking within 8 weeks before surgery was not associated with an increase or decrease in overall postoperative complications for all available studies (relative risk [RR], 0.78; 95% confidence interval [CI], 0.57-1.07), for a group of 3 studies with high-quality scores (RR, 0.57; 95% CI, 0.16-2.01), or for a group of 4 studies that specifically evaluated pulmonary complications (RR, 1.18; 95% CI, 0.95-1.46).
Existing data indicate that the concern that stopping smoking only a few weeks prior to surgery might worsen clinical outcomes is unfounded. Further larger studies would be useful to arrive at a more robust conclusion. Patients should be advised to stop smoking as early as possible, but there is no evidence to suggest that health professionals should not be advising smokers to quit at any time prior to surgery.
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ABSTRACT: Inappropriate hair removal is a risk factor for postoperative surgical site infections (SSIs). A series of obstetric patient awareness interventions were introduced regarding hair self-removal before presentation at hospital. Active inpatient and outpatient surveillance of SSIs following caesarean section was undertaken prospectively. The rate of hair self-removal decreased significantly from 41% (2008) to 27% (2011) after implementation of posters and enhanced prenatal education (P = 0.048). Concurrently, a 51% reduction was seen in the SSI rate following caesarean section. This multi-faceted strategy proved successful in reducing prehospital hair self-removal overall, particularly shaving. Other simultaneous SSI prevention interventions are also likely to have contributed to the reduction in SSI rate.The Journal of hospital infection 10/2012; · 3.01 Impact Factor
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ABSTRACT: BACKGROUND: Smoking cessation before surgery improves perioperative outcomes and some smokers may quit if undergoing surgery. Quitting smoking in community settings is influenced by physician quit advice and knowledge of smoking hazards, but there are few data on whether this applies in perioperative settings. METHOD: Survey on day of surgery of elective patients who reported being a smoker at the time of wait-list placement. Duration of smoking abstinence before surgery (if any) and length timing of failed quit attempts was determined. Sources of any quit advice before surgery, including from physicians, and patient knowledge on hazards of smoking and surgery were questioned. RESULTS: While on the waiting list, 44/177 smokers reported quitting (>24 h) before surgery and 42/177 others made an attempt. Quitting was usually brief. Fewer than 40% of smokers answered yes (correct answer) to questions on whether smoking increased wound infection rates, worsened wound healing, increased anaesthetic complications or increased post-operative pain. Incorrect answers (no) were less likely in quitters than those smoking until surgery (OR 0.41, 95% CI 0.25-0.68). Patients still smoking by admission recalled quit advice from a surgeon in 22.6% of cases, while wait-list quitters recalled surgical quit advice in 43.2% of cases (OR 2.6 95% CI 1.2-5.4 P = 0.01). Effects of general practitioner quit advice were significant (OR 3.2 95% CI 1.5-6.8 P = 0.004) while anaesthetists, nurse and hospital brochure advice were not. DISCUSSION: Improving patient knowledge of the perioperative risks of smoking and increased physician advice to quit may improve smoking abstinence at surgery.ANZ Journal of Surgery 02/2013; · 1.50 Impact Factor