Anesthesiology Smoking Abstinence

Measure Specification

Each year, approximately 10 million cigarette smokers require surgery and anesthesia in the U.S. Smoking is a significant independent risk factor for perioperative heart, lung, and wound-related complications. There now is good evidence that perioperative abstinence from smoking reduces the risk of heart, lung, and wound-related perioperative complications, and that the perioperative period represents a “teachable moment” for smoking cessation that improves long-term abstinence rates.

While a longer duration of abstinence is associated with a greater benefit for patients, even just abstinence on the morning of surgery is associated with reduced levels of nicotine and carbon monoxide levels and a reduced risk of myocardial ischemia and surgical site infections. Evidence shows that perioperative tobacco cessation interventions can 1) increase perioperative abstinence rates in surgical patients who smoke and 2) decrease the rate of perioperative complications.

Recent reviews identified a range of effective interventions, from brief counseling to the use of behavioral therapy and pharmacotherapy, that physicians who care for surgical patients (e.g., anesthesiologists and surgeons) can incorporate into their practices to improve perioperative smoking abstinence. Unfortunately, evidence also suggests that few of these physicians take advantage of the opportunity to intervene, and that many surgical patients still smoke even on the morning of surgery.

If more surgical patients get help to quit smoking around the time of surgery, this will both reduce the rate of smoking-related perioperative complications such as wound infection, and lead to long-term improvements in health, as the average smoker gains 6-8 life years if they quit. Thus, this measure on abstinence on the morning of surgery not only directly affects acute surgical risk, but also serves as a marker for the provision of effective preoperative tobacco use interventions.

Consensus Statement on Perioperative Smoking Cessation: 2020, Society for Perioperative Assessment and Quality Improvement (SPAQI) Interventions should occur as soon as practicable in relation to surgical scheduling. Evidence from observational studies of spontaneous quitting suggests that longer durations of preoperative abstinence are associated with lower rates of respiratory and wound healing complications.

Evidence from RCTs supports an effect of preoperative smoking cessation interventions that are 4- to 8-wk long. However, smoking cessation interventions can be performed at any time before or after surgery—without risk of increased complication rates. Preoperative clinic physicians should counsel patients to quit and refer them to smoking cessation services.

Delivery of smoking cessation interventions by allied health professionals and pharmacists may be a practical way to provide smoking cessation services to surgical patients before and after surgery. Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update, U.S. Department of Health and Human Services Public Health Service It is essential that clinicians and health care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health care setting.

Tobacco dependence treatments are effective across a broad range of populations. Clinicians should encourage every patient willing to make a quit attempt to use the counseling treatments and medications recommended in this Guideline. Brief tobacco dependence treatment is effective. Clinicians should offer every patient who uses tobacco at least the brief treatments shown to be effective in this Guideline.

2023 American Society of Anesthesiologists Statement on Smoking Cessation Based on data published in 2021 by the United States Center for Disease Control (CDC), approximately 11.5% of American adults consume traditional cigarettes and up to half of these individuals will die prematurely from this behavior. In addition, approximately 4.5% of American adults use so-called electronic cigarettes (e-cigarettes).

More worrisome, 3.3% of middle school students and 14.1% of high school students report e-cigarette use in the preceding 30 days. Each year, millions of cigarette and e-cigarette consumers (smokers) require surgery and anesthesia in the United States. Smoking has a direct impact on postoperative outcomes including respiratory complications, cardiac complications, and wound healing.

Abstinence from smoking may improve these outcomes. In addition, the perioperative period may represent a teachable moment for promotion of long-term smoking cessation, with smokers potentially being more receptive to messages urging them to quit. For these reasons, the perioperative period represents an excellent opportunity for smokers to quit smoking.

Patients should abstain from smoking for as long as possible both before and after surgery and should obtain help in doing so. Patients can receive help in a variety of ways, including telephone quitlines (e.g., the Centers for Disease Control’s 1-800-QUITNOW), which are of proven efficacy and are now readily available to all Americans.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period.