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Smoking Cessation Soars with Presurgical Checklist Program

By Debra Shute  
   July 24, 2017

The Strong for Surgery Program is linked to a two-thirds decrease in the rate of smoking in patients undergoing cervical and lumbar spine procedures, according to research from the University of Washington.

A presurgical health-optimization program known as Strong for Surgery has shown dramatic results in getting patients to quit smoking before elective back surgery, according to research presented this week at the American College of Surgeons (ACS) 2017 Quality and Safety Conference.

“People who smoke are two to three times more likely to have a failure of the spine surgical fusion, endure continued pain and dysfunction, and have a reoperation that can cost as much as $100,000,” said lead study author David Flum, MD, MPH, FACS, professor of surgery and associate chair for research at the University of Washington, Seattle.

The intervention, launched by the University of Washington in 2012 and promoted by the ACS since 2016, uses a similar concept to the widely used operating-room checklist, but takes place in the preoperative setting.

To help patients become healthier before surgery, surgeons use the Strong for Surgery smoking checklist to determine patients’ smoking status. The program includes tools to direct patients who smoke to cessation programs and treatment.

For the new study examining the effectiveness of Strong for Surgery, researchers looked at data involving nearly 24,000 patients who underwent cervical or lumbar spine fusion procedures at 18 hospitals across Washington State between 2011 and 2016.

The analysis showed that the proportion of patients who smoked in 2011, before the quality-improvement intervention was introduced, was 36% compared with 12% in 2016.

In addition, smoking cessation counseling surged from 6.14% in 2012 to 42% in 2016.

“In addition to the Strong for Surgery checklist, getting surgeons directly involved in the messaging around cigarette cessation is very powerful, whereas public health interventions are about generic messaging directed at everyone,” Flum said.

“In general, surgery is a very teachable event, so it’s a prime opportunity for patients to take stock of their health, and we find that patients are more apt to listen,” he added.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.


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