MEDICAL INTELLIGENCE Helping Surgical Patients Quit Smoking: Why, When,

Millions of cigarette smokers undergo elective surgery each year. Efforts to help them quit smoking could im-prove immediate perioperative outcomes, such as those related to the cardiac and respiratory systems, and the healing of surgical wounds. Perhaps more im-portantly, the scheduling of elective surgery represents an excellent opportunity for smokers to permanently quit, with great benefit to their long-term health. Al-though it is difficult for smokers to quit, there are now several interventions of proven benefit that can more than double the chances of success. These include sim-ple physician advice to quit, brief behavioral interven-tions that can be provided by physicians or other clini-cians, and pharmacotherapy with drugs such as nicotine. Although specific strategies tailored for the surgical patient remain to be developed, there are steps that anesthesiologists can implement into their prac-tices now that can help their patients quit smoking. (Anesth Analg 2005;101:481–7) A pproximately 23 % of American adults smokecigarettes, and one-third of these individualswill die prematurely because of their use of tobacco (1). Each year, millions of cigarette smokers require surgery and anesthesia. Two major benefits could result from efforts to help them quit smoking. First, smoking increases the risk of some postoper-ative complications, including pulmonary complica-tions such as atelectasis and pneumonia, cardiovas-cular complications such as myocardial ischemia, and wound-related complications such as infection (2,3). Even temporary abstinence from smoking may reduce the risk of these complications and improve surgical outcomes. Second, a surgical episode may represent a “teachable moment ” that encourages smokers to permanently quit, with great benefit to their long-term health. Many physicians are not aware that there has been great progress in recent decades in the treat-ment of tobacco dependence, as summarized in th