Interventions in the preoperative clinic for long term smoking cessation: A quantitative systematic review

  • Amna Zaki
  • Amir Abrishami
  • Jean Wong
  • Frances F. Chung
Reports Of Original Investigations

Abstract

Purpose: To assess the efficacy of interventions offered to patients in the preoperative clinic to promote long-term (≥ three months) smoking cessation following surgery.

Methods: We searched The Cochrane Library, MEDLINE, EMBASE and CINAHL for all randomized controlled trials (RCTs) on smoking-cessation interventions initiated in the preoperative clinic. Trial inclusion, quality assessment, and data extraction were performed independently by two authors. Standard meta-analytic techniques were applied.

Results: Four RCTs (n=610 patients) were included in the review. Interventions included pharmacotherapy, counseling, educational literature and postoperative telephone follow-up. The follow-up period ranged between three to 12 months with only one RCT following up patients for τ one year. Two studies used biochemical methods to validate subjects’ self-reporting of smoking cessation at the follow-up assessment. Overall, the interventions were associated with a significantly higher cessation rate vs control at the three to six month follow-up period (pooled odds ratio: 1.58, 95% confidence interval (CI) 1.02–2.45,P value=0.01, 12=0%). The only trial with longer follow-up period (12 months), however, failed to show any significant difference between the intervention and control groups (odds ratio: 1.05, 95% CI 0.53–2.09,P value=0.88).

Conclusion: This systematic review suggests that smoking-cessation interventions initiated at the preoperative clinic can increase the odds of abstinence by up to 60% within a three- to six-month follow-up period. To evaluate the possibility of longer abstinence, future trials with at least one-year follow-up are recommended.

Interventions en clinique préopératoire pour la cessation du tabagisme: un compte-rendu quantitatif systématique

Résumé

Objectif: Évaluer l’efficacité des interventions destinées à promouvoir la cessation du tabagisme à long terme (≥ trois mois) après une chirurgie mises à la disposition des patients en clinique préopératoire.

Méthode: Nous avons effectué des recherches dans la Bibliothèque Cochrane et les bases de données MEDLINE, EMBASE et CINAHL pour identifier toutes les études randomisées contrôlées (ERC) traitant des interventions de cessation du tabagisme mises en oeuvre en clinique préopératoire. Les critères d’inclusion de l’étude, l’évaluation de la qualité et l’extraction des données ont été menés de façon indépendante par deux auteurs. Les techniques standard de méta-analyse ont été utilisées.

Résultats: Notre compte-rendu a inclus quatre ERC (n=610 patients). La pharmacothérapie, la consultation, la littérature de formation et le suivi postopératoire par téléphone constituaient les interventions analysées. La période de suivi allait de trois à douze mois, une seule étude randomisée contrôlée effectuant un suivi de plus d’un an. Deux études ont eu recours à des méthodes biochimiques pour valider les déclarations volontaires des patients concernant la cessation du tabagisme lors de l’évaluation de suivi. D’une manière générale, les interventions ont été associées à un taux significativement plus élevé de cessation que le groupe témoin à trois et six mois de suivi (rapport de cotes pondéré : 1,58, intervalle de confiance à 95 % (IC) 1,02–2,45, valeur P=0,01, 12=0 %). Cependant, la seule étude comportant une période de suivi plus longue (12 mois), n’a pas montré de différence significative entre les groupes intervention et témoin (rapport de cotes : 1,05, 95 % IC 0,53–2,09, valeur P=0,88).

Conclusion: Ce compte-rendu systématique suggère que les interventions pour la cessation du tabagisme mises en oeuvre en clinique préopératoire peuvent augmenter de 60 % au maximum les chances d’abstinence dans une période de suivi de trois à six mois. Toutefois, nous recommandons des études supplémentaires avec un suivi d’au moins un an pour évaluer la possibilité d’une période d’abstinence plus longue.

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Copyright information

© Canadian Anesthesiologists 2008

Authors and Affiliations

  • Amna Zaki
    • 1
  • Amir Abrishami
    • 1
  • Jean Wong
    • 1
  • Frances F. Chung
    • 1
  1. 1.Department of Anesthesia, Toronto Western Hospital, University Health NetworkUniversity of TorontoTorontoCanada

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