1 “ Stop Before the Op: The short-term benefits of preoperative smoking cessation in London ” Dr Bobbie Jacobson OBE Director

2 Pre-Operative Smoking Cessation: The Context Integral part of Delivery Plan for “Choosing Health” Unique Opportunity to influence patients and their families Smoking in London is responsible for: – £120,000 avoidable hospital admissions a day –11,000 bed days pa –Costs London’s NHS £105 million pa

3 Who Made this Work Possible? Carole Furlong and Barnet/Hounslow PCTs LHO Smokefree London

4 What is the Evidence that Smoking before Surgery is Harmful? Increased risk of lung, heart and infectious complications Impaired wound-healing Reduced bone fusion after fracture Increased risk of dying in hospital Increased length of hospital stay

5 Smoking & Elective Surgery: The Harms vs Benefits Balance Sheet Short Term Benefits Short Term Risks Long Term Benefits Reduction in lung & heart complications Risk of lung complications up to 4 weeks+ before op Reduction in risk of CHD lung & other cancers & premature death Faster wound healing Faster bone fusion time Reduced length of hospital stay

6 Modelling the Impact of Improved Stop Smoking Services for Pre-Op Patients - Assumptions Numbers of smokers admitted for elective surgery Numbers likely to quit (10% conservative estimate, 30% optimistic) Numbers of post op complications Numbers of bed days/potential cost savings

7 Number who would stop smoking PCTTotal current smokers admitted for elective surgery Conservative estimate Optimistic estimate Sutton & Merton Ealing Bromley Enfield Greenwich Lewisham Newham Lambeth Barnet Hillingdon Brent Havering Bexley Croydon City & Hackney Waltham Forest Estimated Number of Smokers Admitted for Elective Surgery from London PCTs

8 Number who would stop smoking PCTTotal current smokers admitted for elective surgery Conservative estimate Optimistic estimate Barking & Dagenham Wandsworth Southwark Hounslow Redbridge Tower Hamlets Haringey Westminster Hammersmith & Fulham Camden Islington Kensington & Chelsea Harrow Richmond & Twickenham Kingston Total for all London PCTs181,28314,59630,457 Estimated Number of Smokers Admitted for Elective Surgery from London PCTs

9 All complications PCTEstimated number of all complications in smokers Conservative estimate for stopping smoking Optimistic estimate for stopping smoking Sutton & Merton Ealing Bromley Enfield Greenwich Lewisham Newham Lambeth Barnet Brent Hillingdon Havering Bexley City & Hackney Croydon Barking & Dagenham Waltham Forest Numbers of complications that could be prevented by stopping smoking

10 Numbers of complications that could be prevented by stopping smoking All complications PCTEstimated number of all complications in smokers Conservative estimate for stopping smoking Optimistic estimate for stopping smoking Wandsworth Southwark Hounslow Tower Hamlets Redbridge Haringey Westminster Hammersmith & Fulham Camden Islington Kensington & Chelsea Harrow Richmond & Twickenham Kingston Total for all London PCTs94, ,385

11 Bed Days Saved by Stopping Smoking Bed days saved by stopping smoking PCTConservative estimate for stopping smoking Mean estimate for stopping smoking Optimistic estimate for stopping smoking Sutton & Merton Ealing Lewisham Lambeth Croydon Enfield Barnet Bromley Brent Hillingdon Greenwich Wandsworth Southwark Bexley Camden Hounslow

12 Bed Days Saved by Stopping Smoking Bed days saved by stopping smoking PCTConservative estimate for stopping smoking Mean estimate for stopping smoking Optimistic estimate for stopping smoking Westminster Haringey City & Hackney Havering Barking & Dagenham Tower Hamlets Newham Hammersmith & Fulham Islington Waltham Forest Redbridge Harrow Kensington & Chelsea Richmond & Twickenham Kingston Total for London1,7202,6553,590

13 Questions for Implementation What service design changes are needed in surgical OPD to be able to deliver a one stop smoking cessation service? How can such a service ensure that cessation advice is given at the right time? Who should lead the OPD intervention? How can the PCT smoking cessation team support the development of the service? How can we ensure that smoking cessation requirements are part of the specification for surgical care?

14 The Size of the Opportunity for Londoners Current Smokers Admitted for Surgery(PCTs) 181,300 Numbers of post-op complications potentially preventable 5300 Potential number of Quitters30,400 Bed Days saved3600 £1.15 Costs Avoided: Up to £1.15 million for PCTs Up to £2.8 million for Trusts

15 Further Information? Further copies of “Stop before the Op” can be downloaded from Copies of the technical report “Preoperative Smoking Cessation: a model to estimate potential short-term health gain and reductions in length of stay, Carole Furlong, Sep 05” can also be downloaded from Have you registered with ?