Systematic review and meta-analysis of short-term and long-term smoking abstinence rates of intensive perioperative smoking cessation programs vs brief interventions for smoking cessation

Background: The perioperative period is an important "teachable moment" where smoking interventions may be particularly effective. We aim to explore the effectiveness of intensive perioperative smoking cessation programs not just on short term, but long term smoking abstinence as well.Methods: This is a systematic review and meta-analysis of randomized controlled trials published between 1 Jan 2007 and 15 May 2022. The studies include perioperative smoking cessation programs that were conducted either in the preoperative surgical clinic or anaesthesia clinic settings. Some programs included follow-up sessions in the postoperative phase. The primary outcomes were short-term and long-term smoking abstinence rates for patients who participated in intensive perioperative smoking cessation programs. Subgroup analyses were also conducted to compare the effects between patients undergoing surgery for smoking-induced and non-smoking induced illnesses.Results: In total, thirteen trials with a total of 2597 smokers undergoing elective surgery were included in the analysis. The pooled results show that patients who participated in intensive perioperative smoking cessation programs had a higher chance of abstinence in both short term (OR: 2.41, 95% CI [1.95 to 2.98], p < 0.001) and long term (OR: 1.64, CI [1.23 to 2.2], p < 0.001) periods postoperatively. This effect was seen regardless of whether patients underwent surgery for smoking-induced or non-smoking induced illnesses.Conclusions: Intensive peri-operative smoking interventions are more effective than brief interventions in achieving both short and long term abstinence. Hospitals should consider integrating structured intensive smoking interventions into perioperative care. Further studies examining the optimal timing and duration of such programs will be useful.