Offering mailed nicotine replacement therapy and Quitline support before elective surgery: a randomised controlled trial

Objective: To assess whether offering free mailed nicotine replacement therapy (NRT) and telephone counselling to smokers on elective surgery waiting lists increases quitting before surgery. Design, setting: Randomised, controlled trial at Frankston Hospital, a public tertiary referral hospital in Melbourne. Participants: Adult smokers added to elective surgery waiting lists for operations at least ten days in the future, 1 April 2019 ‒ 3 April 2020. Intervention: In addition to normal care, intervention participants received a brochure on the risks of low frequency smoking, an offer of Quitline call-back registration, and an offer of mailed NRT according to reported daily smoking: 1‒9 cigarettes/day, 2 mg lozenges; 10‒15/day, 7‒14 mg patches [three weeks] and 2 mg lozenges; > 15/day, 7‒21 mg patches [five weeks] and 2 mg lozenges. Main outcome measures: Primary outcome: quitting at least 24 hours before surgery, verified by exhaled carbon monoxide testing. Secondary outcomes: quitting at least four weeks before surgery, adverse events, and (for those who had quit before surgery) abstinence three months after surgery. Results: Of 748 eligible participants (control, 363; intervention, 385), 516 (69%) had undergone elective surgery when the trial was terminated early (for COVID-19-related reasons) (intervention group, 274; control group, 242). 122 of the 385 intervention participants (32%) had accepted the offer of cessation support. The proportions of intervention participants who quit at least 24 hours before surgery (18% v 9%; odds ratio [OR], 1.97; 95% CI, 1.22‒3.15) or at least four weeks before surgery (9% v 4%; OR, 2.20; 95% CI, 1.08–4.50) were larger than for the control group. Three months after surgery, 27 of 58 intervention (47%) and 12 of 25 control participants (48%) who quit before surgery reported not smoking in the preceding seven days. No major adverse events were reported. Conclusion: Uptake of free mailed NRT and Quitline support by smokers on elective surgery waiting lists was good, and offering additional support was associated with higher proportions of smokers quitting before surgery. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12619000032156 (prospective).