A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Physicians who care for surgical patients witness the devastating consequences of cigarette smoking almost every day. For example, smoking increases the risk of acute complications such as pneumonia and wound infections, and adds to the burden of smoking-related diseases such as heart disease. As we approach November, which is COPD Awareness Month, Lung Cancer Awareness Month and with the Great American Smokeout taking place November 19, we as physicians need to be aware of the important role we can play in helping patients manage their smoking around the time of surgery.
The good news is that having surgery is an excellent time to quit smoking. Studies show patients do not report additional stress when they stop smoking in the hospital, and in particular, do not experience increased cravings for cigarettes. The reasons why are not clear, but could relate to them being out of their routine environment so that normal “cues” for smoking, such as having dinner at home, are not present. Another factor may be that pain medications given after surgery can reduce cravings for cigarettes.
So it is likely smokers will find it much easier than they expect to quit smoking around the time of surgery. Indeed, about half of smokers undergoing cardiac surgery successfully quit permanently after surgery. Other new evidence shows effective medications to help patients quit, including nicotine replacement therapy, are safe for surgical patients to use, and quitting smoking even the day before surgery may be beneficial (and is certainly not harmful).
There is no doubt that quitting smoking in the perioperative period reduces the risk of perioperative complications. And if patients take advantage of the opportunity to quit for good, they will literally add years to their lives. The American Society of Anesthesiologists (ASA) has been working since 2006 to help surgical patients quit smoking, both by educating the public and providing resources to physicians to help their patients quit.
To be sure, there are several challenges to getting physicians involved in helping patients quit smoking, including often limited preoperative patient contact and most physicians have very little training in tobacco control. Rather than trying to make all physicians experts in smoking cessation, the ASA recommends that we act to motivate patients to get connected with the experts: a strategy known as Ask, Advise, and Refer.
First, every patient should be asked whether they use tobacco. Even if your practice uses patient histories obtained by others to document smoking status, you, as a physician, can personally ask about smoking as part of your preoperative evaluation — because patients need to know that you care enough about their smoking to ask.
Next, every smoker needs to be advised to quit. You can concentrate on two points: 1) Abstaining from smoking may help them recover better from their surgery; and, 2) Many people find surgery is a good time to quit permanently. Even if you are seeing the patient only briefly, encourage them to avoid cigarettes for as long as possible after the surgery. Finally, refer patients to free telephone-based counseling (1-800-QUIT-NOW). These telephone quitlines provide free, convenient and effective access to experts who can help people quit smoking, and more than double the chances of success. Many practices now have established tobacco treatment specialist programs that can also be excellent referral resources.
Over 75 percent of smokers want to quit. Studies show they are very receptive to your advice as a physician. It takes less than a minute to: Ask, Advise, and Refer. In that one minute, you can make a lasting difference in the life of your patient who smokes. More than 50 years have passed since the surgeon general’s report confirmed the dangers of smoking — half of patients who smoke will die from a disease caused by smoking. Although most are aware of these dangers, more than 60 million Americans continue to smoke. But more than 10 million of these smokers a year undergo surgery in the U.S., so the potential impact we, as physicians, can have is great — an impact that will last far longer than just the immediate perioperative period.
David O. Warner is an anesthesiologist.
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