Speaking to patients about smoking cessation
Members of the College’s Regional Surgical Adviser Network explain how they speak to patients about smoking cessation
Mark Peter, General, Upper GI and Bariatric Surgeon, York Teaching Hospitals NHS Foundation Trust
“In my elective practice, I give all smokers cessation advice and, if they agree to it, they are given an appointment with the smoking cessation nurse where they have access to a range of resources to help them quit. I find that many patients are keen to stop once the risks and benefits are discussed.
For major surgical intervention, including complex abdominal wall reconstruction, surgery is deferred until patients are successfully non-smoking, which helps lower complications rates, can shorten the length of time in hospital and generally improves outcomes. In my emergency practice, smoking cessation is advised but is not always practical when intervention is required acutely.”
Neil Smart, Consultant Colorectal Surgeon, Royal Devon & Exeter Hospital
“Smoking cessation is very important for the patients I treat and I always try to have a conversation about giving up smoking before surgery. It isn't sufficient to cut down; the greatest benefits will only come with stopping completely. There are many ways to stop, but the NHS smoke free service increases the chances of success.
For patients requiring complex surgery to fix giant hernias of the abdominal wall, smoking greatly increases the risks of complications such as infection, impaired wound healing, re-operation and recurrence of the hernia. Indeed, the risks can be so great that they out-weigh the benefit of the operation and it is strongly advised not to perform planned surgery while the patient continues to smoke.”
Sanjeev Agarwal, Consultant Orthopaedic Surgeon, University Hospital Wales, Cardiff
“All my elective orthopaedic patients are asked to consider stopping smoking and all positive responses are referred to a cessation programme. In most cases, it is not mandatory to stop smoking before surgery, and the operation can still proceed. However, there are some procedures (such as osteotomy, where the bone is cut, realigned and must to knit back together), which are not recommended if patients smoke. This is due to poor circulation that can impair wound and bone healing. For operations like this, cessation of smoking is mandatory, otherwise a different procedure must be considered.”
Michael Woodruff, Consultant Hand, Wrist and Trauma Surgeon, Lancashire Teaching Hospitals NHS Foundation Trust
“I tell patients with fractures that there is good evidence that smoking impairs fracture healing and can increase the risk of fracture non-union, and that this risk is not based upon the number of cigarettes smoked, i.e. one cigarette per day is enough to adversely affect fracture healing.
My approach is to empower the patient to take responsibility for their own body. I tell patients that the fracture is theirs and if they want to give their body the best chance of healing then they will stop smoking. I also highlight that a fracture non-union is harder to treat than a fresh acute fracture. When it comes to fracture healing, the best chance is the first chance.”
Mr Barnabas Rigden Green, Consultant Vascular Surgeon & Associate Clinical Lecturer, James Cook University Hospital, Middlesbrough
“As a vascular consultant, I perform complex surgeries to restore blood flow to a limb, and, on occasion, amputate when there is no other option. As such, it is important for me to address smoking habits with patients and highlight the relationship between smoking and vascular disease.
With established vascular disease, the treatments I offer can fail if a patient continues to smoke. Those who manage to stop do better in the long term than those who continue to smoke.
In our outpatient clinics we have a stop smoking professional counsellor to help our patients who attend our vascular service. This initiative, which is part of the NHS Stop Smoking Service, includes a one-to-one counselling session with helpful literature, portable carbon monoxide detection, access to medication, community support services, and even a gangrenous foot to demonstrate the harmful effects of smoking.”