A perioperative audit of smoking, smoking cessation advice and pharmacological management of nicotine dependence: Are guidelines enough?

This article focuses on perioperative smoking patterns, cessation advice, and pharmacological management of nicotine dependence among non-emergency surgical patients at an Australian tertiary hospital, assessing compliance with guidelines from the Australian and New Zealand College of Anaesthetists (ANZCA) and the Royal Australasian College of Surgeons (RACS). The study found that 16% of patients smoked within 30 days before surgery, with low patient awareness of smoking-related surgical risks and only 54% recalling receiving quit advice, despite guidelines recommending universal cessation counseling. Attendance at the preadmission clinic increased the likelihood of receiving quit advice but did not improve risk awareness or quit attempts, while advice from surgeons was most strongly associated with attempts to quit. Nicotine replacement therapy (NRT) use was low both preoperatively (11%) and postoperatively (7%), and smoking status was not consistently documented in medical records. The findings suggest that existing professional guidelines alone have not substantially improved perioperative smoking cessation practices, highlighting the need for hospital-specific protocols and routine interventions to better support patients in quitting smoking around the time of surgery.