Preoperative smoking cessation interventions: a systematic review and meta-analysis.
Mohammed Alsanad, Mohammed Aljanoubi, Faraj K Alenezi, Amanda Farley, Babu Naidu, Joyce Yeung
Author Information
Mohammed Alsanad: College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia. Alsanad018@gmail.com.
Mohammed Aljanoubi: Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
Faraj K Alenezi: College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Amanda Farley: Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Babu Naidu: Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Joyce Yeung: Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
BACKGROUND: Smoking is the leading single cause of preventable death in England and also increases the risk of postoperative complications. The preoperative period is a potential opportunity to introduce smoking cessation interventions to smokers to reduce the risk of postoperative complications. A systematic search was conducted to find all studies that investigated the effectiveness of preoperative smoking cessation interventions. The primary outcome was smoking cessation at surgical time to the last follow-up, and the secondary outcome was postoperative complications that required treatment or ICU admission. A random-effects meta-analysis was used to synthesize the outcomes. Sixteen studies were included in the review (3505 participants), and 14 studies were included in the meta-analysis (2940 randomized participants). The quality of evidence was moderate due to the high risk of bias and heterogeneity. We found that patients who were provided with a smoking cessation intervention had significantly increased odds of quitting smoking by the time of surgery compared with usual care, with a reported relative risk (95% CI) 1.64 (1.30-2.07) and at the longest follow-ups with RR (95% CI) 1.38 (1.12-1.70). Moreover, there was no difference found in the rate of postoperative complications between intervention and control conditions with RR (95% CI) 0.81 (0.62-1.06). The use of standardized outcome measurements is recommended to reduce heterogeneity for future studies, and further investigation focusing on patient perspectives is needed. TRIAL REGISTRATION: PROSPERO CRD42023423202.
