Stopping smoking prior to elective hip and knee surgery: the impact of visiting a community pharmacist for tobacco management

Abstract

Aim To have patients quit smoking prior to elective total joint arthroplasty surgery. Objective Smokers have twice the rate of deep surgical site infections and three times the rate of readmission to hospital after arthroplasty than non-smokers. We assessed the impact of patients obtaining counselling and medical management for their nicotine addiction by visiting a pharmacist in their community on short and long term quit rates. Methods After ethics approval and written informed consent patients attending a pre-surgical assessment clinic were recruited to participate in a pharmacy delivered smoking cessation program. Patients watched a surgery specific video education about the program and smoking status was validated by exhaled CO determination at 30 days after program participation and by self-reported smoking status at 6 months obtained by telephone follow up. Results 103 out of 286 (36%) patients approached agreed to participate in the community pharmacist program. 52% were female with a mean age (SD) of 59 (8.4) years. Mean (SD) Fagerstrom score was 4.0 (2.2) and years smoked 36.9 (11.3). 79% had tried to quit previously. Despite all participants agreeing to see a pharmacist only 58% attended for a visit. The validated 30-day and 6-month continuous abstinence rate was 16% and 18%, respectively for those who saw a pharmacist vs. 2% for non-participants. Conclusion Participation in this study and the pharmacy visit was voluntary. The participation rate was low but for those motivated to participate and to visit the pharmacist and receive treatment and counselling the short and long terms outcomes were significant. Mandating at least a single visit to a pharmacy-driven smoking cessation program for all patients undergoing joint arthroplasty seems worth exploring to enhance smoking cessation prior to surgery. Funding Global Research Award for Tobacco Dependence - (GRAND) - Pfizer.