ANZCA Bulletin June 2012 - final.pdf - Australian and New Zealand ...

TOBACCO AND SuRGERy:ISSuES OF TITANIC IMPORTANCEOn April 15, 1912, the RMSTitanic sank with loss of morethan 1500 lives 1 . A centurylater, it remains one of theworst peacetime maritimedisasters, caused by failingsthat continue to both shockand fascinate the world 1 .In Australia and New Zealand, 20,000people die annually from tobacco-relateddisease, equivalent to the RMS Titanicsinking in the Tasman Sea every month 2 .Like the Titanic disaster, regulatoryfailure contributes to this tobacco deathtoll. For example, some tobacco productscontain additives, such as ammonia, thatincrease the addictiveness of nicotine (byincreasing its unionised fraction) withoutthe manufacturers being required to statethis on the packaging 3,4 .Gender and class inequity occurred inthe Titanic death toll. Ninety two per centof second-class male passengers diedcompared to 3 per cent of the femalepassengers in first class 1 .Class and gender inequity occurs withthe tobacco death toll too. The poorest20 per cent of Australian men are 1.8times more likely to face premature deathcompared with the wealthiest 20 percent. This is due largely to socio-economicdifferences in smoking prevalence 5 .Many patients quit smoking beforesurgery, particularly those having cardiacsurgery, cancer surgery and other majoroperations 6 . Surgery can promote quittingand quitting itself improves surgicaloutcome, including significant reductionsin wound infection and cardiovascularcomplications 7 . Despite this, evidencesuggests that preoperative clinics do notsystematically provide adequate smokingcessation care to patients having electivesurgery 8,9 . Such organisational failuresmay be costing lives in the same way thatsystemic failings led to unnecessary deathsin the icy Atlantic waters more than100 years ago.Clinicians dropping the ball onsmoking cessationPrior to August 2011, Peninsula Healthprovided little organisational support toencourage smokers to quit before electivesurgery. A survey of pre-admission servicesin Victoria, NSW and the ACT showedwe were not unusual in this regard 9 . Ourwaiting-list patients were sent a brochureentitled “About your anaesthetic”, whichincluded just two lines about smokingon page three:“Give up smoking at least six weeksbefore your surgery to give your lungs andheart a chance to improve. You need tolet the surgeon and anaesthetist know ifyou smoke.”32 ANZCA Bulletin June 2012