The efficacy of a smoking cessation programme in patients undergoing elective surgery: a randomised clinical trial.

It is known that smokers constitute an important risk group of patients undergoing surgery. It is unknown how smoking cessation intervention initiated 4 weeks prior to elective surgery affects the probability of permanent cessation. We randomly assigned 117 patients, scheduled to undergo elective orthopaedic and general surgery, to smoking cessation intervention and control group. The intervention group underwent a programme initiated, on average, 4 weeks prior to surgery with weekly meetings or telephone counselling and were provided with free nicotine replacement therapy (NRT). The control group received standard care. As a result, 20/55 (36%) patients the intervention group vs 1/62 (2%) in the control group became completely abstinent throughout the peri-operative period (p < 0.001). After 1 year, those in the intervention group was most likely to be abstinent (18/55 (33%) vs 9/62 (15%) of the controls (p = 0.03). Level of nicotine dependence and obesity seemed to be a predictor of long-term abstinence (p = 0.02).

Functional outcome and quality of life in patients with Type B ankle fractures: a two-year follow-up study.

OBJECTIVES: To compare a specific score designed for ankle fractures with a general quality-of-life instrument as an outcome measure, and to describe the two-year results for patients with Type B ankle fractures. DESIGN: Follow-up study. SETTING: Large teaching hospital, Sweden. PATIENTS: Fifty-three patients, aged nineteen to sixty-three years, treated operatively for Type B ankle fractures. Forty-one patients completed the follow-up. MAIN OUTCOME MEASUREMENTS: Olerud Molander Ankle Score (OMA score), Short Form-36 Health Survey (SF-36), and a visual analogue scale (VAS). RESULTS: A significant correlation was found between the OMA score and SF-36 subscores for physical functioning, physical and emotional role function, social functioning, and bodily pain (p < 0.05). VAS for physical symptoms correlated with the OMA score and with all SF-36 subscores (p < 0.001). The mean OMA score was 84 (standard deviation = 22.5); 64 percent of patients scored 90 or more. Patients with an OMA score <90 more often had a B3-type fracture (p < 0.05) and more often considered themselves as not recovered compared with patients with an OMA score > or =90 (p < 0.001). Only thirteen patients (36 percent) reported a complete recovery. Sixteen patients (44 percent) had work-related problems and twenty-two (61 percent) had some problems with sport activities. The SF-36 subscores for physical functioning, physical and emotional role function, vitality, and mental health were lower compared with an average Swedish population (p < 0.05). CONCLUSIONS: Our results suggest that the SF-36 Health Survey may be useful in measuring outcome after an ankle fracture, that disability, i.e., self-perceived limitations in everyday life, is common after B-type ankle fractures.