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Strong for Surgery's Smoking Cessation Checklist and Resources

In almost every surgical field, smoking has been linked to worse post-operative complications, from anastomotic leaks in colorectal surgery, to fusion failure in spine surgery, and graft failure in plastic surgery. These complications can significantly impact a patient’s recovery as well as have long-term negative effects on their health. Although some complications may be minor, smoking has also been associated with major complications such as respiratory failure, heart attacks, and death. The good news is that one-half to two-thirds of post-operative complications are preventable by quitting smoking before the operation. 

Despite advances made over the last 50 years in decreasing the prevalence of smoking, almost 15% of the population of Washington State continues to smoke, and despite over half try to quit every year, only a very small fraction of this population will succeed. An upcoming operation can used as a ‘teachable moment’ to incentivize and motivate patients to quit smoking. The Strong for Surgery smoking checklist helps clinicians identify patients at high risk for smoking-related complications and puts the process in motion to assist patients with quitting. The checklist can be used as the starting point for a conversation between the patient and the clinician to gather information about tobacco use, formulate a quit plan and enlist the resources needed to assist in the quitting process. 

These resources may include counseling from the quit line or other formal service, nicotine replacement therapy or other pharmacotherapy, as well as enlisting help from family members or primary care providers. Because smoking cessation can be difficult, patients benefit from a multi-pronged approach; in fact, evidence shows that the more health providers who advise a patient to quit, the better the chances that he or she will make a quit attempt and succeed in remaining abstinent.  Strong for Surgery is committed to identifying existing resources and expanding care pathways for clinicians to integrate into patient care.

Strong for Surgery is excited to work with Dr. Abigail Halperin as a content expert in the fields of tobacco use and smoking cessation. Dr. Halperin is the former Medical Director of Free & Clear's Quit For Life program and is currently the Program Director of the Tobacco Studies Program at the University of Washington. Her research and clinical expertise will help inform the development of resources for both providers and clinicians.

“This is a wonderful opportunity for clinicians to learn how easy and rewarding it is to help their patients quit smoking! Non-judgmental advice to quit by a physician, along with the offer of help, relieves patients’ guilt about their smoking and their shame at not being unable to quit on their own, making them 3-5 times more likely to quit. Patients think it is their fault that they have become addicted to cigarettes and that they should be able to quit on their own, but this is not true. Nobody chose to become addicted to tobacco, and cigarettes are the most addictive substance known to humans. Helping a patient quit is the most effective and cost-effective treatment we have in all of medicine to improve a patient’s health in both the short and long term. It is never too late for a patient to benefit from quitting, but the sooner the better.”

Strong for Surgery would like to hear from stakeholders interested in joining a workgroup to inform the development of the checklist, clinician and patient resources. The group will convene for the first time in early autumn. For more information, please email



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