A perioperative audit of smoking, smoking cessation advice and pharmacological management of nicotine dependence: Are guidelines enough?

Smoking increases anaesthetic and surgical complications. The perioperative period provides an opportunity to give advice and initiate ongoing support to patients who smoke. Our aims were to determine perioperative smoking patterns and how well patients were supported to reduce smoking as well as compliance with the Australian and New Zealand College of Anaesthetists guidelines on smoking. We surveyed all adults having non-emergency surgery at Wollongong Hospital over an 8-week period in 2021. For those who smoked, we analysed their medical record for identification of smoking status and smoking cessation pharmacotherapy prescription. Sixteen per cent of patients (n = 111) had smoked in the 30 days before surgery. Of that group, 83% did not think that smoking might cause a problem with their surgery or anaesthetic, and 46% did not report receiving advice to stop smoking. When advice to stop smoking was given, it was associated with an attempt to quit, especially when given by a surgeon. Attendance at the preadmission clinic was associated with the provision of smoking cessation advice but not a quit attempt. Nicotine replacement therapy was used by 11% prior to surgery, and only 7% immediately post-surgery. Our findings show low rates of perioperative smoking cessation advice and nicotine replacement therapy prescription, similar to those reported by other studies over the past two decades in Australia. It provides further evidence that the Australian and New Zealand College of Anaesthetists and other society guidelines alone have not led to major improvements in our management of perioperative smoking, and that hospital-specific routine interventions are needed.