Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial

Background Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than nonsmokers. Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement. Methods We did a randomised trial in three hospitals in Denmark. 120 patients were randomly assigned 6-8 weeks before scheduled surgery to either the control (n=60) or smoking intervention (60) group. Smoking intervention was counselling and nicotine replacement therapy, and either smoking cessation or at least 50% smoking reduction. An assessor, who was masked to the intervention, registered the occurrence of cardiopulmonary, renal, neurological, or surgical complications and duration of hospital admittance. The main analysis was by intention to treat. Findings Eight controls and four patients from the intervention group were excluded from the final analysis because their operations were either postponed or cancelled. Thus, 52 and 56 patients, respectively, were analysed for outcome. The overall complication rate was 18% in the smoking intervention group and 52% in controls (p = 0.0003). The most significant effects of intervention were seen for wound-related complications (5% vs 31%, p = 0.001), cardiovascular complications (0% vs 10%, p = 0.08), and secondary surgery (4% vs 15%, p = 0.07). The median length of stay was 11 days (range 7-55) in the intervention group and 13 days (8-65) in the control group. Interpretation An effective smoking intervention programme 6-8 weeks before surgery reduces postoperative morbidity, and we recommend, on the basis of our results, this programme be adopted.