Printed quit-pack sent to surgical patients at time of waiting list placement improved perioperative quitting.

BACKGROUND: This study aimed to measure the effects of sending a smoking cessation 'quit-pack' to all patients placed on the elective surgical waiting list. METHOD: Questionnaire-based study before intervention (mid-2011, 177 patients) and after (2012/13, 170 patients) conducted on day of surgery. All were identified as adult smokers at time of waiting list placement at an outer metropolitan Melbourne public hospital. The intervention was a quit-pack consisting of educational brochure containing cessation advice and focused on perioperative risks of smoking, together with Quitline referral form and reply-paid envelope. The primary outcome measure was proportion of smokers who quit on waiting list for ≥1 month before surgery, considered a clinically meaningful duration to reduce surgical complications. RESULTS: An 8.6% improvement in waiting list smokers achieving the target ≥1 month abstinence at day of surgery (P = 0.03). The number needed to treat of 12 (95% confidence interval 6-240) meant 12 smokers receiving intervention would create one additional episode of clinically meaningful quitting on wait list. CONCLUSION: Smoking cessation outcomes before elective surgery are significantly improved by systematic application of a printed intervention delivered at time of wait list placement that encourages and supports perioperative quitting.

Smokers know little of their increased surgical risks and may quit on surgical advice.

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.

Preadmission processes may improve length of stay for colorectal surgery.

BACKGROUND: The preadmission process (PAP) is known to reduce length of stay prior to surgery, but there are few data on its effects on postoperative stay. The aim of the present study was to test the hypothesis that a PAP may reduce postoperative length of stay as well as the preoperative length of stay. METHODS: An audit of admission and discharge times for patients having major colorectal surgery was undertaken to determine the impact of the preadmission process at Dandenong Hospital. One hundred and two elective patients were identified over a 12-month period. RESULTS: The 71 patients admitted through the preadmission process had a 10.7-day average length of stay compared to 18.4 days if the patients were admitted directly by the surgeon. The reduction in length of stay was contributed to by 4 days less preoperatively and 4 days less postoperatively. Thus the benefits from a preadmission service can be realized both at admission and discharge. The nature of this impact of preadmission requires further investigation. CONCLUSIONS: The PAP will reduce preoperative length of stay. Utilization of a PAP also appears to reduce postoperative length of stay and may reduce postoperative complications. Further investigation is required to determine the exact nature and extent of these PAP benefits.