[Smoking prevention in preoperative patient factsheets]

Introduction: Information for patients undergoing elective surgery is often supported by factsheets. This information is required for ethical and legal reasons. Among the 11 million surgical procedures performed annually in France, three million concern smokers. Data of a 2005 French Expert's conference show that smoking doubles or triples the risk of postoperative complications and quitting smoking cancels this risk.

Methods: By a query on www.google.fr, 100 factsheets were collected in 2009 (pilot study) and 500 in 2012. These factsheets were systematically analyzed on tobacco information. Issuers were contacted by mail, email and telephone to suggest improvements on these factsheets. A return to the websites where the 500 factsheets have been issued was performed 6 months later.

Results: In 2009, only 24.0% of factsheets mentioned tobacco. In 2012, 29.4% of factsheets evoked tobacco. When tobacco is mentioned, information's were rarely complete. Cosmetic surgeons, maxillofacial surgeons and to a lesser extent orthopaedists are those who raise most often the tobacco issue. After contact with issuers, 41 factsheets were removed from the sites. Factsheets with tobacco information increased from 147/500 (29.4%) to 175/459 (38.1%) and the quality score of the information increased from 3.4 to 6.0. The message suggested by OFT was: "Smoking increases the risk of surgical complications of any surgery. Quitting smoking 6-8 weeks before surgery eliminates this additional risk. If you smoke, talk to your doctor, your surgeon and your anesthesiologist or call the French quitline TIS 3989 to help you to reduce the risk and put all the chances on your side". This sentence was included in 54 factsheets.

Conclusion: There is still work to do to improve information's on smoking risk in perioperative factsheets. The aim is to reduce postoperative complications, costs and avoid court sentences against practitioner who do not inform properly on the risks of smoking on surgical procedures.