120 <strong>Australasian</strong> <strong>Anaesthesia</strong> <strong>2011</strong>Smoking <strong>and</strong> surgery: time to clear the air 121The third challenge is to advocate within our health systems for effective <strong>and</strong> sustainable programs for smokingcessation based on established evidence-based models. Fund providers of acute care in hospitals may balk atfunding requests for hospital-based interventions where the savings are not immediately apparent. This is unfortunateas even an intensive preoperative smoking cessation clinic model was shown to be cost-effective in terms ofreducing overall hospital costs. 61 More long-term community savings could be expected than reported in a hospitalcostanalysis as many patients remain smoke-free 12 months or more after discharge from these programs. 10Anecdotally, very few health services in Australasia have systematic programs for patients joining surgical waitinglists that identify smokers <strong>and</strong> give them information <strong>and</strong> support on how to quit before surgery. Peninsula Healthin Melbourne is currently commencing <strong>and</strong> evaluating a program where all smokers on the surgical waiting list willreceive a brochure explaining the benefits of quitting as well as a reply-paid referral letter to enable Quit Victoria tocommence free preoperative telephone counselling sessions*. No other Victorian health service systematicallyrefers elective surgical patients to quit (I. Ferreter, personal communication), yet referral to Quitline is an integralpart of smoking cessation guidelines for <strong>Australian</strong> general practice. 48The scale of the task is a challenge but also a significant opportunity for public health improvement. In the2009/10 year there were 1.9 million elective operations in Australia, two thirds of which were in the private sector. 22In <strong>New</strong> Zeal<strong>and</strong> public hospitals, there were 137,279 elective operations over the same period (C. Lewis, personalcommunication). Based on the current smoking prevalence it is likely that at least 360,000 smokers have electivesurgery in our region each year. As cardiothoracic, vascular <strong>and</strong> certain cancer surgery is over-represented amongstsmokers, this figure is probably conservative. Worldwide, an estimated 70 million smokers undergo major surgeryeach year. 26CONCLUSIONBefore he died of lung cancer at the young age of 45, the great US musician Nat King Cole asked his doctor to“get me well so I can get on television <strong>and</strong> tell people to stop smoking” 62 . It was too late for Nat <strong>and</strong> his cancerdenied him that opportunity. Yet by routinely enquiring about smoking habits, advising to stop <strong>and</strong> referring forfurther help, anaesthetists can act on their favourable opportunity to end the misery that tobacco inflicts on manylives. Regarding smoking <strong>and</strong> surgery, it is time to clear the air.*Further information, brochure template <strong>and</strong> fax referral form, visit clinician’s area atwww.stopbeforetheop.blogspot.comREFERENCES1. Buerk M: The Oxford Dictionary of Humorous Quotations, 2nd edition. Edited by Sherrin N. Oxford, OUP, 2005,p. 285.2. 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