Surgeons successfully delivered a brief smoking cessation intervention to patients preparing for peripheral artery disease surgery; initial results suggest the pre-surgery period may be a “teachable moment” for encouraging patients to quit smoking.
Feasibility and Pilot Efficacy of a Brief Smoking Cessation Intervention Delivered by Vascular Surgeons in the Vascular Physician Offer and Report (VAPOR) Trial
Published in: Journal of Vascular Surgery, [Epub February 2017], doi 10.1016/j.jvs.2016.10.121
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- Is it feasible to have surgeons deliver an intervention to get patients with peripheral arterial disease to quit smoking?
This study determined the feasibility and potential efficacy of an evidence-based standardized smoking cessation intervention delivered by vascular surgeons to smokers with peripheral arterial disease.
We performed a cluster-randomized trial of current adult smokers referred to eight vascular surgery practices from September 1, 2014, to July 31, 2015. A three-component smoking cessation intervention (physician advice, nicotine replacement therapy, and telephone-based quitline referral) was compared with usual care. The primary outcome was smoking cessation for 7 days, assessed 3 months after the intervention. Secondary outcomes were patients' nicotine dependence and health expectancies of smoking assessed using Patient Reported Outcomes Measurement Information System (PROMIS; RAND Corporation, Santa Monica, Calif).
We enrolled 156 patients (65 in four intervention practices, 91 in four control practices), and 141 (90.3%) completed follow-up. Patients in the intervention and control practices were similar in age (mean, 61 years), sex (68% male), cigarettes per day (mean, 14), and prior quit attempts (77%). All three components of the intervention were delivered to 75% of patients in intervention practices vs to 7% of patients at control practices (P < .001). At 3 months, 23 of 57 patients (40.3%) in the intervention group quit smoking (23 of 56 patients quit who completed follow-up, plus 1 death included in the analysis in the denominator as a smoker), and 26 of 84 patients (30.9%) In the control group quit smoking (26 patients of 84 who completed follow-up, including 2 deaths included in the denominator as smokers). This difference (40.3% quit rate in intervention, 31% quit rate in control; P = .250) was not statistically significant in crude analyses (P = .250) or analyses adjusted for clustering (P = .470). Multivariable analysis showed factors associated with smoking cessation were receipt of physician advice (odds ratio for cessation, 1.96; 95% confidence interval, 1.28-3.02; P < .002) and nicotine replacement therapy (odds ratio, 1.92; 95% confidence interval, 1.43-2.56; P < .001).
Implementation of a brief, surgeon-delivered smoking cessation intervention is feasible for patients with peripheral arterial disease. A larger trial will be necessary to determine whether this is effective for smoking cessation.
- Three-quarters of patients in the intervention group received all three components of the intervention, suggesting that it is feasible to integrate smoking cessation effectively into a surgical workflow.
- Patients in the intervention group did not quit smoking at a significantly higher rate than patients in the control group.
- Patients most likely to quit smoking were those who received advice from physicians and support on nicotine replacement therapy.