(P211) CUTTING SMOKING RATES IN HALF PRIOR TO CARDIOVASCULAR SURGERY

Background: Due to the cardiovascular and perioperative implications of smoking on patients' health, the ERAS guidelines have a class 1 recommendation that cardiovascular surgery patients abstain from smoking before surgery (Engelman et al., 2019). Extensive literature demonstrates the benefits of a perioperative smoking cessation program as it helps patients undergo surgery safely, recover successfully, gain a healthy postoperative lifestyle, and achieve better survival outcomes (Iida et al., 2022). Furthermore, the preoperative period offers a “teachable moment” that has been shown to almost double quit smoking rates (Iida et al., 2022) and reduces the risk of postoperative complications by 41% (Mills et al., 2011).

METHODS AND RESULTS: In 2021, a tertiary cardiac care hospital expanded its cardiac rehabilitation division to include a prehabilitation program to optimize their patients prior to elective cardiovascular surgery. Within the division, includes an Advanced Practice Nurse (APN) led smoking cessation department, with the purpose of offering smoking cessation appointments to all patients who have used any form of tobacco in the previous 6 months. The smoking cessation program was adapted for elective cardiovascular surgery patients to have virtual appointments with nurses every two weeks leading up to their surgery. During the appointments, the nurses provide counselling on overcoming obstacles, and provide patients with education and support. The patients are mailed nicotine replacement therapy (NRT) at no cost to their homes for the duration of the program.

After the second year of program implementation, a total of 150 patients joined the smoking cessation prehabilitation program. A staggering 50.7% of patients were smoke free at the time of surgery, 37.3% of patients had reduced their tobacco use before surgery and only 12% of patients had no change in their tobacco use. During their hospital admission for cardiovascular surgery, the patients receive further counselling, are prescribed NRT and offered smoking cessation follow-up program, which 72% accept.

Conclusion: A key consideration for the future of the program will be to look at continuous smoking abstinence rates at 6 months after surgery in patients who participated in the smoking cessation prehabilitation program. In conclusion, implementing an APN led smoking cessation initiative and taking advantage of the preoperative period was shown to be greatly effective in increasing cessation rates and should be included in all prehabilitation programs.