INNOVATION FUND Innovation, Integration, & Implementation Patient Safety and Quality of Care SHOWCASE 2016 INNOVATION FUND Innovation, Integration, & Implementation Patient Safety and Quality of Care SHOWCASE 2016

Development and Implementation of a Perioperative Smoking Cessation Program with Computer-Based Patient Education

Patient Safety and Quality of Care


Jean Wong


MSH UHN Academic Medical Organization, University of Toronto


Patients who smoke put themselves at increased risk for serious surgical complications ranging from wound infections to respiratory problems and even death. It is not currently routine practice to educate patients about the risk of complications brought on by smoking – and how patients can decrease the risk – prior to surgery. Our team has developed a patient e-learning education program tailored specifically for surgical patients aimed at assisting them to quit smoking. This patient e-learning program can be used as a stand-alone program or as part of a multi-pronged program.  Our patient educational program overcomes some of the barriers such as a lack of time  to provide smoking cessation interventions. Twenty-two percent of smokers who participated in our program quit smoking and remained abstinent 6 months after their surgery. This rate of abstinence is much higher than the spontaneous unassisted quit rate of 6-8% in the general population. Our e-learning program will be made available in our preoperative  clinics and on our institution’s website so that it will be  accessible for all smokers having surgery at our institution. We plan to make this e-learning program available to all smokers having surgery in Ontario, Canada, and world-wide.


Background: Smoking increases the risk of surgical complications. Using the preoperative period as a ‘teachable moment’ to educate and assist every smoker scheduled for surgery to reduce their risk by quitting smoking will encourage short- and long-term abstinence.  Our objective was to develop a patient e-learning module to educate patients about the risks of smoking, and to determine whether implementing the  patient e-learning module as part of a preoperative smoking cessation program would increase the rate of short- and long-term abstinence from smoking in elective surgical patients.


Methods:  After Research Ethics Board approval, self-reported smokers > 18 years of age undergoing elective surgery who consented to participate in this multi-center trial were enrolled. The  program consisted of the patient e-learning module, a brief motivational counseling session, and/or pharmacotherapy with nicotine replacement therapy or varenicline, referral to Smokers’ Helpline, and educational pamphlets. The 7-day point prevalence abstinence on the day of surgery, 1, 3 and 6 month after surgery was recorded. Univariate analysis and multivariate logistic regression was used to model the most important predictors at each stage of the quit period.

Results: A total of 459 patients participated in the study. The quit rates on the day of surgery, 1, 3, and 6 months after surgery were: 22.2%, 28.5%, 25.5% and 22.2%, respectively. The presence of another smoker in the house, greater amount spent on cigarettes, use of pharmacotherapy, and contact with Smokers’ Helpline predicted abstinence.

Conclusions: A preoperative cessation intervention utilizing a patient e-learning module as part of a preoperative smoking cessation program was effective for helping patients quit smoking at the time of surgery and 6 months after surgery.

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