Peri-operative tobacco cessation interventions: a systematic review and meta-analysis

S Harrogate; J Barnes; K Thomas; A Isted; G Kunst; S Gupta; S Rudd; T Banerjee; R Hinchliffe; R Mouton

doi:10.1111/anae.16120

Peri-operative tobacco cessation interventions: a systematic review and meta-analysis

S Harrogate^*, J Barnes, K Thomas, A Isted, G Kunst, S Gupta, S Rudd, T Banerjee, R Hinchliffe, R Mouton

^*Corresponding author for this work

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

22 Citations (Scopus)

Abstract

Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20-1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29-2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.

Original language	English
Pages (from-to)	1393-1408
Number of pages	16
Journal	Anaesthesia
Volume	78
Issue number	11
Early online date	1 Sept 2023
DOIs	https://doi.org/10.1111/anae.16120
Publication status	Published - 9 Oct 2023

Bibliographical note

Funding Information:
The study protocol was prospectively published in PROSPERO (CRD42022351992). RH and RM are joint senior authors. This study was supported by the North Bristol NHS Trust and the University of Bristol. SH is supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund. RM is supported by the North Bristol Vascular Surgery Charitable Trust. KT is funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship. The work was funded by a grant from the Association for Cardiothoracic Anaesthesia and Critical Care and the Vascular Anaesthesia Society of Great Britain and Ireland via the National Institute for Academic Anaesthesia. We are incredibly grateful for this support, which has enabled us to perform this research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Wellcome Trust or the University of Bristol. No competing interests declared.

Funding Information:
The study protocol was prospectively published in PROSPERO (CRD42022351992). RH and RM are joint senior authors. This study was supported by the North Bristol NHS Trust and the University of Bristol. SH is supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund, grant number: 204813/Z/16/Z. RM is supported by the North Bristol Vascular Surgery Charitable Trust. KT is funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship, grant number: PDF-2017-10-068. The work was funded by a grant from the Association for Cardiothoracic Anaesthesia and Critical Care and the Vascular Anaesthesia Society of Great Britain and Ireland via the National Institute for Academic Anaesthesia, grant number: WKRO-2022-0029. We are incredibly grateful for this support, which has enabled us to perform this research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Wellcome Trust or the University of Bristol. No competing interests declared.

Publisher Copyright:
© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

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title = "Peri-operative tobacco cessation interventions: a systematic review and meta-analysis",

abstract = "Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95\%CI) 1.48 (1.20-1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95\%CI) 1.62 (1.29-2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.",

author = "S Harrogate and J Barnes and K Thomas and A Isted and G Kunst and S Gupta and S Rudd and T Banerjee and R Hinchliffe and R Mouton",

note = "Funding Information: The study protocol was prospectively published in PROSPERO (CRD42022351992). RH and RM are joint senior authors. This study was supported by the North Bristol NHS Trust and the University of Bristol. SH is supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund. RM is supported by the North Bristol Vascular Surgery Charitable Trust. KT is funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship. The work was funded by a grant from the Association for Cardiothoracic Anaesthesia and Critical Care and the Vascular Anaesthesia Society of Great Britain and Ireland via the National Institute for Academic Anaesthesia. We are incredibly grateful for this support, which has enabled us to perform this research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Wellcome Trust or the University of Bristol. No competing interests declared. Funding Information: The study protocol was prospectively published in PROSPERO (CRD42022351992). RH and RM are joint senior authors. This study was supported by the North Bristol NHS Trust and the University of Bristol. SH is supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund, grant number: 204813/Z/16/Z. RM is supported by the North Bristol Vascular Surgery Charitable Trust. KT is funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship, grant number: PDF-2017-10-068. The work was funded by a grant from the Association for Cardiothoracic Anaesthesia and Critical Care and the Vascular Anaesthesia Society of Great Britain and Ireland via the National Institute for Academic Anaesthesia, grant number: WKRO-2022-0029. We are incredibly grateful for this support, which has enabled us to perform this research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Wellcome Trust or the University of Bristol. No competing interests declared. Publisher Copyright: {\textcopyright} 2023 The Authors. Anaesthesia published by John Wiley \& Sons Ltd on behalf of Association of Anaesthetists.",

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AU - Harrogate, S

AU - Barnes, J

AU - Thomas, K

AU - Isted, A

AU - Kunst, G

AU - Gupta, S

AU - Rudd, S

AU - Banerjee, T

AU - Hinchliffe, R

AU - Mouton, R

N1 - Funding Information: The study protocol was prospectively published in PROSPERO (CRD42022351992). RH and RM are joint senior authors. This study was supported by the North Bristol NHS Trust and the University of Bristol. SH is supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund. RM is supported by the North Bristol Vascular Surgery Charitable Trust. KT is funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship. The work was funded by a grant from the Association for Cardiothoracic Anaesthesia and Critical Care and the Vascular Anaesthesia Society of Great Britain and Ireland via the National Institute for Academic Anaesthesia. We are incredibly grateful for this support, which has enabled us to perform this research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Wellcome Trust or the University of Bristol. No competing interests declared. Funding Information: The study protocol was prospectively published in PROSPERO (CRD42022351992). RH and RM are joint senior authors. This study was supported by the North Bristol NHS Trust and the University of Bristol. SH is supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund, grant number: 204813/Z/16/Z. RM is supported by the North Bristol Vascular Surgery Charitable Trust. KT is funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship, grant number: PDF-2017-10-068. The work was funded by a grant from the Association for Cardiothoracic Anaesthesia and Critical Care and the Vascular Anaesthesia Society of Great Britain and Ireland via the National Institute for Academic Anaesthesia, grant number: WKRO-2022-0029. We are incredibly grateful for this support, which has enabled us to perform this research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Wellcome Trust or the University of Bristol. No competing interests declared. Publisher Copyright: © 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

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N2 - Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20-1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29-2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.

AB - Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20-1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29-2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.

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DO - 10.1111/anae.16120

M3 - Review article (Academic Journal)

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JO - Anaesthesia

JF - Anaesthesia

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ER -

Peri-operative tobacco cessation interventions: a systematic review and meta-analysis

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Bibliographical note

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