n the United States, an estimated 25.9 million men (23.9 percent) and 20.7 million women (18.1 percent) are smokers.1 In spite of decades of dire warnings about the dangers of smoking, people of all ages continue to use cigarettes and other tobacco products. In response to the continuing tobacco epidemic, ASA formed a Smoking Cessation Initiative Task Force in 2006.

While there are many “stop smoking” programs available today, the ASA initiative differs because we focus on not only the long-term health benefits of not smoking but immediate benefits of stopping smoking for as long as possible before and after surgery. Smokers require special consideration when undergoing anesthesia for a surgical procedure because smoking complicates anesthesia management and increases the risks of complications such as myocardial ischemia and wound-related complications. The good news is that quitting smoking can decrease the risk of these complications. Our ultimate goal is to increase abstinence rates for surgical patients who smoke, thus improving surgical outcomes and long-term health.

As a component of the ASA Smoking Cessation Initiative, we are advocating the “Ask-Advise-Refer” program. This program offers physicians practical advice on how to engage their patients in a conversation about their tobacco habits without taking much time and without needing to be an expert in tobacco control. The idea is to encourage anesthesiologists to advise their patients to quit smoking, then refer them to expert resources that can help them.

Physicians should first ask their patients if they smoke. If the answer is yes, you should advise the patient to stop smoking, at least around the time of their surgery. Because many of the effects of smoke constituents such as nicotine and carbon monoxide dissipate within about 12 hours, patients should be especially encouraged not to smoke the morning of surgery — just as they should not eat, they also should not smoke. Finally patients can be referred to get assistance in quitting, such as to the national tobacco quit line (800) QUIT-NOW. Quitlines provide free, confidential, extending telephone counseling services that are available to all Americans.

This ASA task force has developed a variety of resources to help both anesthesiologists and their patients. These resources can be found at the ASA Web site: www.asahq.org/ patientEducation/smoking_cessation.htm. The Web site includes helpful, free information such as a video, provider and patient brochures, PowerPoint presentations and talking points on how to quit smoking. The Web site also provides information about how anesthesiologists can in some situations receive reimbursement from Medicare for providing stop-smoking advice. You can also refer patients to the video “Stop Smoking Before Surgery,” now located on www.youtube.com and www.Yahoo.com/videos.

The Task Force recently conducted a pilot program in which the Ask-Advise-Refer program was implemented in 14 anesthesiology practices across the country, including a mix of academic and private practices. This pilot program was quite successful, with good acceptance by both anesthesiologists and patients. A plan to roll out the Ask-Advise-Refer technique nationally is under development along with a marketing and public relations strategy designed to reach larger audiences with this important public health initiative.

ASA member David O. Warner, M.D., an anesthesiologist at the Mayo Clinic, heads the Smoking Cessation Initiative on behalf of ASA. Other task force members include Daniel R. Briggs, M.D., Lowell Dale, M.D., Patricia J. Davidson, M.D., Michael H. Entrup, M.D., C. Alvin Head, M.D., Scott Hernberg, D.O., Zeev N. Kain, M.D., and Stanley W. Stead, M.D.

The ASA Smoking Cessation Initiative Task Force emphasizes that by addressing patient smoking behavior, anesthesiologists have a unique opportunity to improve surgical outcomes, make a lasting difference in the lives of their patients (the average smoker gains six to eight years of life if he/she quits), and demonstrate to the public that we are truly perioperative physicians concerned with this important determinant of patient health.

Reference:
1 National Health Interview Survey (NHIS), 2005, National Center for Health Statistics.