ANZ J. Surg. 2002; 72: 618–622 ORIGINAL ARTICLE Original Article NOVEL STRATEGY TO STOP CIGARETTE SMOKING BY SURGICAL PATIENTS: PILOT STUDY IN A PREADMISSION CLINIC MELANIE J. HAILE,* JOHN H. WIGGERS,* † ALLAN D. SPIGELMAN, †‡ JENNY KNIGHT,* † ROBYN J. CONSIDINE* † AND KAREN MOORE ‡ *Hunter Centre for Health Advancement, Wallsend, † University of Newcastle, Callaghan and ‡ Hunter Area Health Service, New South Wales, Australia Background: Evidence-based guidelines suggest that all services, wards and clinics within hospitals consider smoking status a vital sign and routinely provide cessation care. Despite this, such opportunities are currently under-utilized. The aim of the present pilot study was to determine the potential effectiveness, feasibility and acceptability of computer delivery of smoking cessation advice to surgical preadmission patients. Methods : All smokers attending a non-cardiac surgical preadmission clinic at the John Hunter Hospital, New South Wales, com- pleted a brief computerized smoking cessation intervention programme. Nine months following completion of the programme, patients completed a follow-up telephone interview that assessed their smoking status and the acceptability of the programme. Results : At follow up, 22 of the 37 participants (60.0%) reported that they had stopped smoking prior to their surgery 9 months previously. Of the 37 participants at follow up, five reported that they were no longer smokers at that time, a cessation rate of 13.5%. Among those patients still smoking, a trend toward smoking fewer cigarettes was evident. Of the 56 smokers at baseline, all com- pleted the computerized smoking cessation programme, with an average completion time of 21 min. A large majority of the smokers (80%) and non-smokers (88%) found that the provision of smoking cessation advice by the computer was appropriate and acceptable. Extrapolation of the results to a full year suggests a cost per quitter of $443. Conclusions : An interactive computerized smoking cessation programme is an acceptable and feasible method of routinely encouraging surgical preadmission clinic patients to stop or reduce their smoking. Further development and testing of the efficacy of this approach is required. Key words: computerized programme, smoking cessation, surgery. INTRODUCTION Smoking remains the largest single preventable cause of death and disability in Australia. 1 Each year, 19 019 deaths are attribut- able to smoking 2 as are approximately 142 525 episodes of hospitalization. 2 Smoking is estimated to cost the Australian community A$6 billion annually. 3 Despite the existence of a wide variety of initiatives designed to control such harm and cost, 4 limited decreases in smoking rates 2 reinforce the ongoing need to develop and test sustainable smoking-related harm reduction strategies. Evidence-based guidelines developed in both Australia 5 and overseas 6–8 are unequivocal in recommending that smoking ces- sation advice be given routinely during every consultation in a range of health care settings. Such recommendations are based on findings that devoting even a few minutes of a consultation to smoking advice may result in an increase in cessation rates com- pared to no advice or usual care. 9,10 Hospitals offer a wide range of services to a patient, each with the potential to provide opportunistic smoking cessation inter- vention. Guidelines suggest that all services, wards and clinics within hospitals should consider smoking status a vital sign and develop procedures for its routine recording and treatment. 6,7 The event of surgery is an ideal opportunity to encourage patients to stop smoking. In addition to the public health benefits of permanent smoking cessation, 11 additional short-term benefits accrue to patients who quit smoking prior to surgery, including increased analgesia and anaesthesia effectiveness, decreased risk of intraoperative pulmonary complications, 12 reduced postopera- tive complications, 13–15 and coping with hospital non-smoking policies. Most booked surgical patients will attend a preoperative education or preadmission visit prior to surgery. Encouraging smokers to stop smoking prior to surgery is a relevant and accepted component of existing preoperative consultations. 13 There has been relatively little research concerning smoking cessation among hospital patients undergoing surgery, and among such patients in a preadmission setting. 16 A pilot study of a nurse-administered smoking cessation educational intervention in a surgical preadmission clinic in the United Kingdom found a significant increase in the proportion of patients who stopped or reduced smoking compared to patients who received routine care. 17 A further randomized controlled trial involving preadmis- sion surgical patients 18 found significantly higher smoking cessa- tion rates at 3 months post surgery among women (control 17%; intervention 35%) but not men (control 20%; intervention 18%). These data suggest the potential for intervention in the preadmis- sion setting to produce valuable smoking cessation outcomes among surgical patients. Despite the potential of providing smoking cessation advice in hospital settings generally, and for surgical patients specifically, existing opportunities for increasing cessation rates in these M. J. Haile BA (Hons), M Appl Psych; J. H. Wiggers BA (Hons), PhD; A. Spigelman MD, FRACS; J. Knight BA, M Med Sci; R. J. Considine BA, Dip Med Sci; K. Moore RN. Correspondence: John H. Wiggers, Hunter Centre for Health Advancement, University of Newcastle, Locked Bag 10, Wallsend, New South Wales 2287, Australia. Email: john.wiggers@hunter.health.nsw.gov.au Accepted for publication 3 May 2002.