title: Urinary cotinine testing as pre-operative assessment of patients undergoing free flap surgery.
abstract: BACKGROUND
  The identified risks of smoking with regard to operated tissues are so elevated that it is clearly dangerous to operate a smoker when the proposed intervention is neither vital nor urgent.
  
  
  METHODS
  The aim of this prospective study was to evaluate a simple method of screening patients who smoke, with the evaluation carried out before agreeing to carry out free tissue transfer. The purpose of the testing was to hold the patient responsible for his actions and minimize smoking-related complications by cancelling or postponing the planned operation if the patient continued to smoke. Screening included use of a standardized questionnaire at the first consultation and detection of cotinine using a urine test strip 7 days before the scheduled surgery. Patients were informed that in the event of positive results, the operation would not take place. A six-week preoperative smoking cessation period was mandatory.
  
  
  RESULTS
  Seventy-six patients were included in this study. Among them, 25 (32.9%) reported being former smokers and 11 (14.5%) admitted in the initial questionnaire to being active smokers. Six patients (7.9%), including one self-reported non-smoker, tested positive for cotinine, and their operations were cancelled.
  
  
  CONCLUSIONS
  Screening using a questionnaire and cotinine detection appeared to constitute a simple, inexpensive, rapid and reliable test. It allowed us to refuse to operate 6 non-compliant patients and was thereby likely to diminish morbidity in the free tissue transfers carried out in our ward.
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: c.reinbold@hotmail.fr.
authors.forename: C
authors.initials: C
authors.lastname: Reinbold
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Rausky
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Binder
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de chirurgie plastique, hôpital Saint-Louis, AP-HP, 75010 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Revol
mesh_terms: D003367:Cotinine / Q000652:urine*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011300:Preoperative Care; D011446:Prospective Studies; D011934:Reagent Strips; D012907:Smoking / Q000652:urine*; D011795:Surveys and Questionnaires
chemical_list: D011934:Reagent Strips; D003367:Cotinine
keywords: Chirurgie plastique; Cotininuria; Cotininurie; Dépistage; Free flaps; Lambeaux libres; Plastic surgery; Screening; Tabac; Tissue transfers; Tobacco; Transferts tissulaires