The prevalence of smoking and e-cigarette use before lung cancer surgery

Abstract

Introduction: Postoperative pulmonary complications are the most common complication in patients following lung cancer surgery, with smoking the biggest risk factor for their development. We aimed to determine smoking and e-cigarette use and validate the use of exhaled carbon monoxide (eCO) in patients before surgery for suspected/confirmed lung cancer.

Methods: Patients were approached on the morning of the thoracic pre-operative clinic, typically 1-2 weeks before the date of surgery. Data collected over an 8-month period (June 2018 to February 2019) included patients self-reported smoking, e-cigarette use and eCO measurement. A current smoker defined by those self-reported to smoke or an eCO>10ppm. An ex-smoker defined as self-reported to have quit with an eCO≤10 ppm. A never smoker defined as those who have smoked <100 cigarettes in a lifetime.

Results: Of the 84 patients approached, there were 17 current smokers (19%), 56 ex-smokers (67%) and 12 never smokers (14%). There was a significant difference in eCO between smoking and ex-smoking groups (p<0.0001) but no difference between the ex-smokers and never smokers (p=0.993). Of the current smokers identified, 4 of 17 patients (24%) self-reported to have stopped for a minimum of 4 weeks but had an eCO>10ppm. There were 9 patients (11%) using e-cigarettes, including 5 ex-smokers and 4 smokers. None of the current smokers had been seen by a stop smoking expert and only 4 of the ex-smokers received support to stop smoking.

Conclusion: 1 in 5 patients continue to smoke prior to thoracic surgery as confirmed by use of eCO measurements. E-cigarettes are being used, but few patients are being supported by specific smoking services to help them quit before surgery.