Multicomponent Smoking Cessation Program for Surgical Patients

Updated: Jan 07, 2021
Evidence Rating:
Near Top Tier


  • Program:

    A multicomponent smoking cessation program for adult smokers with an upcoming elective, ambulatory, or inpatient surgery.

  • Evaluation Methods:

    A well-conducted randomized controlled trial (RCT) in Toronto, Canada with a sample of 296 patients with surgery scheduled in the next 7-60 days.

  • Key Findings:

    12 months after program entry, the biochemically-confirmed smoking abstinence rate was 42% in the treatment group versus 26% in the control group. This difference was highly statistically significant.

  • Other:

    The program was delivered by seven trained anesthesiologists or pharmacists in two Toronto-area hospitals. A replication RCT conducted in other sites would be desirable to hopefully confirm these findings and establish that they generalize to other settings.

This is a multicomponent program designed to encourage adults with an elective, ambulatory, or inpatient surgery in the next 7-60 days to quit smoking. It consists of four components: (i) a 10-15 minute structured counseling session during the patient’s preoperative visit, conducted by an anesthesiologist or pharmacist with specialized training in smoking cessation, that includes advice to quit smoking, information regarding smoking behavior, and selection of a target quit-date (up to 24 hours before the date of surgery); (ii) pharmacotherapy that includes a free three-month supply of varenicline (a prescription medication to treat nicotine addiction); (iii) an educational pamphlet; and (iv) a fax referral to Smokers’ Helpline, which provides proactive telephone outreach and counseling within 48 hours of the patient’s preoperative visit.[1] The program’s cost has not been reported but is likely modest given its brevity.

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[1] Smokers’ Helpline is a free tobacco cessation, telephone-counseling service operated by the Canadian Cancer Society.

Wong, Jean, Amir Abrishami, Sheila Riazi, Naveed Siddiqui, Eric You-Ten, Jennifer Korman, Sazzadul Islam, Xin Chen, Maged Andrawes, Peter Selby, David T. Wong, and Frances Chung (2017). A Perioperative Smoking Cessation Intervention with Varenicline, Counseling, and Fax Referral to a Telephone Quitline versus a Brief Intervention: A Randomized Controlled Trial. Anesthesia & Analgesia 125 (2): 571-579.