Biomedical subjects

N Villebro

Publications and source records attributed to N Villebro.

3 recordsLinked to original sources

PubMed2005

Interventions for preoperative smoking cessation.

BACKGROUND: Smokers have a substantially increased risk of intra- and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. The preoperative period may be a well chosen time to offer smoking cessation interventions due to increased patient motivation. OBJECTIVES: The objective of this review was to assess the effect of preoperative smoking intervention on smoking cessation in the postoperative period and longer term. We also set out to determine the effect of smoking cessation on the incidence of postoperative complications. SEARCH STRATEGY: The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text and keywords (surgery) OR (operation) OR (anaesthesia) or (anesthesia). MEDLINE, EMBASE and CINAHL were also searched, combining tobacco- and surgery-related terms. Most recent search February 2005. SELECTION CRITERIA: We considered randomized trials which recruited smokers prior to surgery, offered a smoking cessation intervention, and measured abstinence from smoking in the preoperative and postoperative periods. We also considered randomized trials of the effect of smoking cessation on the incidence of intra- and postoperative complications. DATA COLLECTION AND ANALYSIS: The authors independently assessed studies to determine eligibility. The results were discussed between the authors. MAIN RESULTS: Four trials met the inclusion criteria. All trials significantly reduced preoperative smoking but the effect sizes were heterogeneous so a pooled effect was not estimated. Only two trials reported the effect of the smoking intervention on wound complications, and the results were heterogeneous, with a significant reduction in wound-related complications, cardiopulmonary complications and the overall risk of any complication in one trial, and no evidence of a difference in complications in the other. The effect on longer term smoking cessation was not significant in either of the two trials with follow up beyond the perioperative period. AUTHORS' CONCLUSIONS: Preoperative smoking interventions are effective for changing smoking behaviour perioperatively. Direct evidence that reducing or stopping smoking reduces the risk of complications is based on two small trials with differing results. The impact on complications may depend on how long before surgery the smoking behaviour is changed, whether smoking is reduced or stopped completely, and the type of surgery.

Humans↗

PubMed2003

A study of the impact of long-term tobacco smoking on postoperative intensive care admission.

Smoking is a risk factor for intra-operative pulmonary complications and a wide range of postoperative pulmonary, cardiovascular, infection and wound-related complications. These may all lead to unplanned postoperative intensive care admission. We tested the hypothesis that smokers have an increased incidence of postoperative intensive care admission and more postoperative complications than nonsmokers in a general and orthopaedic surgical population. The following information was assessed in 6026 surgical patients: age, sex and smoking status (pack-years), history of heart and lung disease, American Society of Anesthesiologists (ASA) physical classification, intensive care admission and postoperative complications. Two thousand five hundred and twenty-six (46%) were smokers but for 620 patients (10.3%) smoking status was not confirmed. Postoperative intensive care admission was required by 319 patients (5.3%). Patients with > 50 pack-years were admitted to the intensive care more frequently than were smokers with < or = 50 pack-years history and nonsmokers (p < 0.001). Ex-smokers with > 50 pack-years history had the same risk of postoperative admission to intensive care as smokers with > 50 pack-years history. Smokers admitted to intensive care with > 50 pack-years history had a higher incidence of chronic lung disease (p < 0.005) and heavy alcohol consumption (p < 0.001). These smokers also had a higher incidence of postoperative pulmonary complications (odds ratio = 3.91, p < 0.01). The mortality rate was 37% in smokers with > 50 pack-years history and 24% in nonsmokers (odds ratio = 2.02, p = 0.08). We conclude long-term tobacco smoking (> 50 pack-years) carries a higher risk of postoperative admission to intensive care, and there seems to be a dose relationship between the amount of tobacco consumed and the risk of postoperative intensive care admission.

Adult↗

PubMed2001

Interventions for preoperative smoking cessation.

BACKGROUND: Smokers have a substantially increased risk of intra and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. The preoperative period may be a well chosen time to offer smoking cessation interventions due to increased patient motivation. OBJECTIVES: The objective of this review was to assess the effect of preoperative smoking intervention on smoking cessation in the postoperative period and longer term. We also set out to determine the effect of smoking cessation on the incidence of postoperative complications. SEARCH STRATEGY: The specialised register of the Tobacco Addiction Group was searched using the free text and keywords (surgery) OR (operation) OR (anaesthesia) or (anesthesia). The databases "EMBASE" and "CINAHL" were also searched, combining tobacco and surgery related terms. SELECTION CRITERIA: We considered randomised trials which recruited smokers prior to surgery, offered a smoking cessation intervention, and measured abstinence from smoking in the pre-operative and post-operative periods. We also considered randomised trials of the effect of smoking cessation on the incidence of intra and post-operative complications. DATA COLLECTION AND ANALYSIS: The reviewers independently assessed studies to determine eligibility. The results were discussed between the reviewers. MAIN RESULTS: No trial meeting the inclusion criteria was found. REVIEWER'S CONCLUSIONS: We found no evidence to determine the effectiveness of pre-operative interventions in helping people to stop smoking, or of the effectiveness of smoking cessation in reducing peri-operative complications. However, observational evidence suggests benefits in stopping smoking before surgery. Although there is no direct evidence about which interventions work best in patients preparing for surgery, behavioural and pharmacological interventions shown to be effective in other settings should be considered.

Humans↗