Smoking cessation programs initiated as late as 4 weeks prior to surgery reduce perioperative morbidity and mortality, yet outpatient smoking cessation interventions are rarely provided. Our aim was to develop a functional, evidence based, outpatient smoking cessation program, including a novel 'opt out' consultation.  The main objectives were testing the feasibility of implementing our approach and maximizing smoker retention within the program.

A needs assessment was done in our outpatient colorectal surgery clinic to assess the prevalence of smoking, how often smoking cessation was addressed and what, if any, methods of intervention were employed.  A multidisciplinary team developed a novel smoking cessation protocol, focusing on efficiency and ease of use. Customized consultation forms and prescriptions were made to facilitate the process and relevant staff received training. A novel ‘opt out’ approach was employed.

Our needs assessment found that 70 of 369 (19%) surgical patients were current smokers. Less than 10% of patients were asked about smoking, and none of the smokers were offered any intervention. The opt-out approach resulted in 78% of smokers joining the program. After two months of implementation, 29 patients (average age 48.8, 58.6% male, average smoking 16 cigarettes/day) received smoking cessation interventions, 23 agreed to automated follow-up support, and 19 received quit cards providing free nicotine replacement therapy. 

Our team has developed a fast, easy to use smoking cessation protocol for outpatient surgical clinics, with a successful early implementation in our colorectal surgery clinics. Importantly, the novel opt-out approach has doubled the usual retention rate of smokers accepting to join the program - 78% vs 35%. This protocol has already been adopted in our department of medicine outpatient clinics, and we hope to spread this to other outpatient surgical clinics.  Six-month smoking cessation outcomes are being collected and efficacy will be reported at a later date.

Retaining smokers in a smoking cessation program: Implementation of a novel evidence based smoking cessation program in an outpatient colorectal surgery clinic