A Cochrane review [Abstract] 1 included 13 studies with a total of 2 010 subjects. Two trials initiated multisession face to face counselling at least 4 weeks before surgery whilst 7 used a brief intervention. Nicotine replacement therapy was offered or recommended to some or all participants in 8 studies. Subgroup analyses showed that both intensive and brief intervention significantly increased smoking cessation at the time of surgery (RR 10.76, 95% CI 4.55 to 25.46; 2 studies, n = 210 and RR 1.30; 95% CI 1.16 to 1.46; 7 trials, n = 1141, respectively). Four trials (n = 556) evaluating the effect on long-term smoking cessation found a significant effect (RR 1.61, 95% CI 1.12 to 2.33; statistical heterogeneity, I2 = 58%). However, when pooling intensive and brief interventions separately, only intensive intervention retained a significant effect on long-term smoking cessation (RR 2.96, 95% CI 1.57 to 5.55; 2 studies, n = 209).
Seven trials (n = 535) examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. A subgroup analyses showed a significant effect of intensive intervention on any complications (RR 0.42, 95% CI 0.27 to 0.65; 2 studies, n = 210) and on wound complications (RR 0.31, 95% CI 0.16 to 0.62; 2 studies, n = 210). For brief interventions, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19; 4 trials, n = 493 for any complication and RR 0.99; 95% CI 0.70 to 1.40; 3 trials, n = 325 for wound complications).
In a multicenter, single-blinded, randomized, controlled trial 2, smokers with a fracture of the lower or upper extremity that needed acute surgical treatment were randomized to an intervention group (n = 50) or a control group (n = 55). The intervention group was offered a standardized smoking cessation program for 6 weeks, and all patients were followed at 2-3 weeks, 4 weeks, and 6-12 weeks. More patients in the control group had postoperative complications than in the intervention group (38% vs 20%, respectively). The rates of superficial wound infection, the most frequently recorded complication in both groups, were 20% and 8% (nonsignificant). A secondary analysis showed that the odds of having a complication were 2.51 times (95% confidence interval, 0.96 to 6.9 times) higher in the control group than in the intervention group.
A database study 3 assessing 30-day complications and readmission following laparoscopic sleeve gastrectomy and laparoscopic Roux-En-Y gastric bypass in smokers included 133 417 patients (12 424 =9.3% were smokers). Smokers more frequently experienced complications. The likelihood of death or serious morbidity (OR 1.13, 95% CI 1.01 to 1.26), readmission (OR 1.21, 95% CI 1.10 to 1.33), wound (OR 1.44, 95% CI 1.24 to 1.68), and respiratory complications (OR 1.69, 95% CI 1.34 to 2.14) were greater in smokers.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
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