Interventions in the preoperative clinic for long term smoking cessation: a quantitative systematic review.
OBJECTIVE
To assess the efficacy of interventions offered to patients in the preoperative clinic to promote long-term (> or = 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 > 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, I(2) = 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).


CONCLUSIONS
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.
Zaki
Amna
A
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
Abrishami
Amir
A
Wong
Jean
J
Chung
Frances F
FF
D000328:Adult; D003376:Counseling / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012907:Smoking / Q000188:drug therapy / Q000523:psychology / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data*; D013995:Time; D016896:Treatment Outcome