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Orthopedic surgeons infrequently altered surgical management of patients who use tobacco
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A recent survey showed surgical management of patients who use tobacco was infrequently altered by orthopedic surgeons.
Researchers distributed 300 paper surveys to general orthopedists and specialty-trained orthopedic surgeons who attended the American Academy of Orthopaedic Surgeons 2012 Annual Meeting to better understand how patients’ use of nicotine influenced preoperative and postoperative management of elective surgery.
Overall, researchers had a response rate of 70% with 211 orthopedic surgeons who responded to the survey. When deciding whether to electively operate on patients who were using nicotine, results showed 11% of all respondents almost always considered tobacco use vs. 16% almost never took nicotine use into account. Researchers noted 81% of surgeons either never delayed surgery or delayed surgery by fewer than 3 months for patients who used nicotine, while 4% of surgeons delayed surgery for 6 months or longer.
According to results, 98% of orthopedic surgeons said they preoperatively counseled patients who used tobacco on the increased risk posed by nicotine use for postoperative outcomes. However, researchers noted 53% spent fewer than 5 minutes counseling patients. Perioperative tobacco cessation programs were frequently or almost always used by 20% of orthopedic surgeons. Researchers found 37% of orthopedists prescribed postoperative nicotine replacement vs. 54% who did not take such action. Perioperative discussion about the risks of nicotine use was documented by 86% of orthopedic surgeons, according to results.
“Studies are needed to determine why few surgeons frequently alter the management of nicotine users and what modifications in orthopedic practice could improve outcomes for these patients,” the researchers wrote. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopWilliam R. Beach, MD
This study and paper provide important information to assist the surgeon regarding why smoking is so deleterious to our patients. Most orthopedic surgeons may be aware of the general negative affects but, like myself, not as informed as we could/should be on this important issue.
The electronic medical record has smoking cessation as a verifiable quality metric for all physicians. Most surgeons likely do little more than to provide the smoking cessation information and receive credit for the achieved metric.
The larger question is providing information to the patient and helping guide them in their health care from an evidence-based perspective. That may require surgeons to make more difficult decisions such as, “We cannot operate on you until you … ”
Also, interesting that the insurers have not been more proactive with recommendations on the subject of surgical intervention while patients engage in tobacco use. In this day of value = outcomes/cost, anything that negatively affects outcomes will negatively affect value. As always, education of patients, providers and payers will be necessary to improve the value of health care.
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