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

2. 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. 3 Who Made this Work Possible? Carole Furlong and Barnet/Hounslow PCTs LHO Smokefree London

4. 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. 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. 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. 7 Number who would stop smoking PCTTotal current smokers admitted for elective surgery Conservative estimate Optimistic estimate Sutton & Merton89907241510 Ealing76556161286 Bromley75356071266 Enfield74295981248 Greenwich73395911233 Lewisham71925791208 Newham69645611170 Lambeth69645611170 Barnet65675291103 Hillingdon62765051054 Brent62665041053 Havering60994911025 Bexley59874821006 Croydon5908476993 City & Hackney5903475992 Waltham Forest5840470981 Estimated Number of Smokers Admitted for Elective Surgery from London PCTs

8. 8 Number who would stop smoking PCTTotal current smokers admitted for elective surgery Conservative estimate Optimistic estimate Barking & Dagenham5826469979 Wandsworth5724461962 Southwark5719460961 Hounslow5674457953 Redbridge5560448934 Tower Hamlets5540446931 Haringey5379433904 Westminster5260423884 Hammersmith & Fulham4856391816 Camden4716380792 Islington4002322672 Kensington & Chelsea3895314654 Harrow3849310647 Richmond & Twickenham3352270563 Kingston3017243507 Total for all London PCTs181,28314,59630,457 Estimated Number of Smokers Admitted for Elective Surgery from London PCTs

9. 9 All complications PCTEstimated number of all complications in smokers Conservative estimate for stopping smoking Optimistic estimate for stopping smoking Sutton & Merton4675128267 Ealing3980109227 Bromley3918107224 Enfield3863106221 Greenwich3816104218 Lewisham3740102214 Newham362199207 Lambeth362199207 Barnet341593195 Brent325989186 Hillingdon326389186 Havering317287181 Bexley311385178 City & Hackney307084175 Croydon307284175 Barking & Dagenham303083173 Waltham Forest303783173 Numbers of complications that could be prevented by stopping smoking

10. 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 Wandsworth297681170 Southwark297481170 Hounslow295181169 Tower Hamlets288179165 Redbridge289179165 Haringey279777160 Westminster273575156 Hammersmith & Fulham252569144 Camden245267140 Islington208157119 Kensington & Chelsea202555116 Harrow200255114 Richmond & Twickenham174348100 Kingston15694390 Total for all London PCTs94,26725785,385

11. 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 & Merton85132178 Ealing74115155 Lewisham72111150 Lambeth72111150 Croydon69106143 Enfield66102138 Barnet65100135 Bromley6397131 Brent6296129 Hillingdon6296129 Greenwich6195128 Wandsworth6093126 Southwark5889120 Bexley5789120 Camden5789120 Hounslow5788118

12. 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 Westminster5585114 Haringey5382111 City & Hackney5280108 Havering5077105 Barking & Dagenham4976103 Tower Hamlets4976102 Newham4874100 Hammersmith & Fulham4874100 Islington477297 Waltham Forest467195 Redbridge446892 Harrow385979 Kensington & Chelsea365676 Richmond & Twickenham365676 Kingston294662 Total for London1,7202,6553,590

13. 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. 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. 15 Further Information? Further copies of “Stop before the Op” can be downloaded from www.lho.org.ukwww.lho.org.uk 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 www.lho.org.uk www.lho.org.uk Have you registered with www.lho.org.uk ?www.lho.org.uk