Cigarette smoking; smoking cessation; reuse of endoscope accessories; conscious sedation

AORN Journal,  Feb, 2005  by George Allen

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Cigarette smoking and postoperative complications

Acta Orthopaedica Scandinavica June 2004

Cigarette smoking is a known risk factor for the development of serious postoperative complications, including delayed wound healing and nonunion after orthopedic procedures. The purpose of this prospective study was to determine whether patients who were smokers who underwent tibia osteotomy by the hemicallotasis technique had longer healing time and more complications than patients who were not smokers who underwent the same procedure. (1)

Hemicallotasis involves attaching the knee with pins to an external frame-like device that lengthens the deformed part of the knee during a period of several weeks. The smoking history of 200 consecutive patients who were undergoing hemicallotasis was noted preoperatively. Patients were classified as nonsmokers (n = 166) if they stated that they had never smoked or had stopped smoking more than six months before the procedure. Thirty-four patients were classified as smokers. The duration of external fixation (ie, from surgery until the pins were removed) and complications, such as delayed wound healing, pseudoarthrosis, septic arthritis, deep vein thrombosis, nerve injury, and pin-site infection, were determined. Common statistical techniques, including analysis of variance, t test, chi-square test, and logistic regression techniques, were used to analyze differences between the groups.

Findings. Fifty-one patients had one or more complications, including delayed wound healing, pseudoarthrosis, septic arthritis, deep vein thrombosis, nerve injury, and pin-site infection. Patients in the smokers group required an average of 16 more days in external fixation and had significantly more complications than patients in the nonsmokers group (smokers: 17/34 versus nonsmokers: 34/166, P = .001). Patients in the smokers group were two and one-half times more likely to develop complications than patients in the nonsmokers group (relative risk 2.5, 95% confidence interval [CI] 1.5-4.7). Multivariate analysis revealed that cigarette smoking was the greatest preoperative risk factor for complications (odds ratio 5.1, P = .001, 95% CI 2.2-12).

Clinical implications. This study found that patients who smoked were more than twice as likely to develop complications after undergoing hemicallotasis than were patients who did not smoke and that delayed healing and pseudoarthrosis were more common among patients who smoked than patients who did not smoke. Perioperative nurses should understand that smoking is an important risk factor for the development of complications after orthopedic surgery; consequently, they should increase their efforts to educate patients on strategies that can facilitate smoking cessation.

Smoking-cessation intervention for surgical patients

Research in Nursing & Health June 2004

Approximately 4,000 substances, many of which have direct physiological links to surgical outcomes, have been identified in cigarette smoke. Smoking cessation before surgical procedures, therefore, is one of the most important preoperative preparation procedures patients can perform to decrease their risk for negative surgical outcomes. The purpose of this randomized study was to test an intervention designed to help smokers abstain from smoking before surgery and achieve long-term smoking cessation. (2) The study's three hypotheses were as follows.

* Participants in the treatment group will be significantly more likely than participants in the control group to abstain from smoking for at least 24 hours before surgery.

* Six months after surgery, the rate of smoking abstinence of participants in the treatment group will be significantly higher than that of participants in the control group.

* Twelve months after surgery, the rate of smoking abstinence of participants in the treatment group will be significantly higher than that of participants in the control group.

Patients who identified themselves as current smokers (N = 237) who were admitted for preoperative assessment at a large urban teaching hospital in Canada were randomly assigned to one of two groups. Group I (ie, the treatment group) received counseling and nicotine replacement therapy. The preadmission clinic intervention included a 15-minute face-to-face counseling session and a kit that included nicotine replacement gum, pamphlets, stress reduction aids, distracters, and a hotline number to call for further assistance and advice. In-hospital, immediate postoperative interventions included a 24-hour postoperative review of patients' smoke-fasting progress and encouragement to continue their smoking fast for the next 10 days to promote wound healing and move to the next step in the smoking cessation process. Beginning one week after the in-hospital visit, participants received weekly telephone counseling that continued for 16 weeks after discharge.

Group II (ie, the control group) received routine preoperative assessment. Common statistical techniques, including univariate and logistic regression techniques, were used to analyze differences between the groups.