Smoking cessation rates in primary care before surgery: a retrospective cohort study

Background: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary care is scarce. Aims and Objectives: The Stop Smoking before Surgery Project (SSSP) started in Porvoo, Finland, in May of 2016. The goals of the project were smoking awareness and preoperative smoking cessation. Our study aimed to evaluate outcomes of the project. Methods: This was an observational, retrospective, cohort study. We studied the recording of surgical patients´ smoking status, ICD-10 diagnosis of nicotine dependence, and the initiation of smoking cessation, both in the primary care, as well as at the surgical outpatient clinic of Porvoo Hospital. The study involved patients operated between May and December of 2016. Electronic patient records served as the information source on the variables analyzed. Clinical research nurses collected the data, which were then evaluated by a trained physician. Results: The study involved 1482 surgical patients. Smoking status was visible in 14.2% of primary care referrals, and in 18.4% of outpatient clinic records. Corresponding rates for current smokers (n=275) were 0.0 and 8.7% for ICD-10 diagnosis of nicotine dependence, and 2.2 and 15.3% for preoperative smoking cessation. The differences between primary care referrals and outpatient clinic records were statistically significant for all three variables (p≤0.001). Conclusions: In primary care, very little attention was paid to preoperative smoking cessation. Rates were significantly better in the surgical outpatient clinic, but still low. Our results call for future research on ways to improve smoking cessation rates.