Effectiveness of Pre-Operative Smoking Cessation Interventions: A Systematic Review and Meta-Analysis

Abstract

Introduction: Smoking is a significant risk factor for postoperative complications, including cardiovascular, pulmonary, and wound-related issues. Pre-operative smoking cessation is widely recommended to mitigate these risks, but the effectiveness of different interventions remains uncertain. This systematic review and meta-analysis aim to evaluate the effectiveness of pre-operative smoking cessation interventions in reducing smoking rates and postoperative complications across various surgical settings. Method: A comprehensive search was conducted across databases including Medline/PubMed, Embase, CINAHL, and CENTRAL, up to July 2024, following PRISMA guidelines. Randomized controlled trials (RCTs) assessing the effectiveness of pre-operative smoking cessation interventions were included. Data were extracted on intervention types, smoking cessation outcomes, and postoperative complications. The Cochrane Collaboration tool was used to assess the risk of bias, and a random-effects meta-analysis was performed to pool the results. Result: Out of 9,188 studies identified, 24 met the inclusion criteria, encompassing 4,712 patients. The pooled analysis revealed that pre-operative smoking cessation interventions significantly increased the likelihood of smoking cessation before surgery, with a pooled risk ratio (RR) of 1.93 (95% CI: 1.56–2.37). However, there was substantial heterogeneity among the studies (I² = 77.14%), indicating variability in the effectiveness of the interventions. Postoperative complication outcomes varied, with some studies showing significant reductions in wound-related complications and overall postoperative risks, while others showed minimal effects. The risk of bias was generally low across studies, although variability in blinding practices and other biases was noted. Conclusion: Pre-operative smoking cessation interventions are effective in increasing smoking cessation rates and, in some cases, reducing postoperative complications. The effectiveness varies depending on the type and intensity of the intervention. Despite some methodological limitations in the included studies, the findings support the integration of structured smoking cessation programs into pre-operative care to improve surgical outcomes. Further research is needed to optimize these interventions and assess their impact on specific types of postoperative complications