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Will preoperative smoking cessation programs generate long-term cessation? A systematic review and meta-analysis.

Berlin NL, Cutter C, Battaglia C. Will preoperative smoking cessation programs generate long-term cessation? A systematic review and meta-analysis. The American journal of managed care. 2015 Nov 1; 21(11):e623-31.

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OBJECTIVES: The aim of this review was to examine published randomized controlled trials (RCTs) and quasi-experimental studies that evaluate the association between preoperative smoking cessation programs and long-term smoking cessation at a minimum of 6 months, postoperatively. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic review was performed utilizing MEDLINE, EMBASE, CINAHL, PSYCHinfo, and COCHRANE databases. All eligible studies of smoking-cessation interventions initiated preoperatively, with cessation measured at a minimum of 6 months postoperatively, were identified. The effect of cessation interventions at 12 months postoperatively in RCTs was evaluated through meta-analyses using Mantel-Haenszel risk ratios (RRs) and 95% CIs. A fixed effects model was conducted initially; however, due to heterogeneity in study characteristics and patient cohorts, a more conservative random effects model was also performed. RESULTS: Four RCTs and 4 quasi-experimental studies were included. Two RCTs demonstrated an association between interventions and cessation at 12 months, and the quasi-experimental studies showed cessation rates of 48% to 56% at 12 months, postoperatively. In a fixed effects model, interventions were associated with a greater likelihood of cessation at 12 months (RR, 1.50; 95% CI, 1.05-2.15; P = .02), although this effect was not statistically significant after applying a random effects model (RR, 1.61; 95% CI, 0.88-2.96; P = .12). CONCLUSIONS: The literature suggests that preoperative smoking cessation programs will likely precipitate long-term ( = 12 months) cessation. Additional studies should identify approaches that optimize preoperative cessation programs in the promotion of short-term, and long-term cessation.

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