***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Patients who smoke cigarettes suffer increased postoperative morbidity . A prospect i ve , controlled trial was design ed to evaluate the effectiveness of written pre‐operative advice to stop smoking before admission for elective surgery and to record the duration of abstinence  immediately before the operation . Although the advice was ineffective in persuading patients to stop smoking , it was associated with a reduction in the amount of tobacco consumed . Nicotine and carbon monoxide have important short‐term adverse effects but 15 % of all patients continued to smoke within an hour of surgery . If patients are unable to give up cigarette smoking completely , it is still worthwhile stopping on admission to hospital OBJECTIVE This study evaluated the reach , initial effectiveness , and potential moderators and mediators of results of a smoking reduction program . DESIGN A generally representative sample of 320 adult smokers from an HMO , scheduled for outpatient surgery or a diagnostic procedure , were r and omized to enhanced usual care or a theory-based smoking reduction intervention that combined telephone counseling and tailored newsletters . MAIN OUTCOME MEASURES Self-reported number of cigarettes smoked and carbon monoxide levels . RESULTS The intervention enrolled 30 % of known eligible smokers and produced reductions of 3 cigarettes per day greater than enhanced usual care . Intervention participants were significantly more likely than control participants to achieve at least a 50 % reduction in self-reported number of cigarettes using complete cases , imputation analyses , and intent-to-treat procedures . Similar patterns were seen for carbon monoxide results but were significant only in complete case analyses . The intervention was generally robust across patient characteristics ( e.g. , education , ethnicity , health literacy , and dependence ) and phone counselors . CONCLUSION Initial results suggest that this program has potential to reach and assist smokers who may not participate in cessation programs . Additional research is indicated to enhance intervention effects , assess maintenance , and evaluate public health impact OBJECTIVE Cancer patients who smoke are advised to quit smoking to reduce treatment complications and future cancer risk . This study 's main objective was to evaluate the efficacy of a novel , presurgical cessation intervention in newly diagnosed cancer patients scheduled for surgical hospitalization . METHOD We conducted a parallel-arm , r and omized controlled trial comparing the efficacy of our hospital-based , tobacco cessation " best practice s " treatment model ( BP ; cessation counseling and nicotine replacement therapy ) with BP enhanced by a behavioral tapering regimen ( scheduled reduced smoking ; BP + SRS ) administered by a h and held computer before hospitalization for surgery . Cessation outcomes were short ( hospital admission and 3 months ) and longer-term ( 6 months ) biochemically verified smoking abstinence . We hypothesized that BP + SRS would be superior to BP alone . One hundred eighty-five smokers were enrolled . RESULTS Overall , 7-day-point prevalence , confirmed abstinence rates at 6 months for BP alone ( 32 % ) and BP + SRS ( 32 % ) were high ; however , no main effect of treatment was observed . Patients who were older and diagnosed with lung cancer were more likely to quit smoking . CONCLUSION Compared to best practice s for treating tobacco dependence , a presurgical , scheduled reduced smoking intervention did not improve abstinence rates among newly diagnosed cancer patients .reserved ) Background : Telephone quitlines that provide counseling support are efficacious in helping cigarette smokers quit and have been widely disseminated ; currently , they are underused . Surgery represents a teachable moment for smoking cessation , which can benefit surgical outcomes ; however , few surgical patients receive smoking cessation interventions . This study developed and tested a clinician-delivered intervention to facilitate quitline use by adult patients scheduled for elective surgery . Methods : After formative work involving patients and clinicians , a brief intervention was design ed to facilitate telephone quitline use . It was then evaluated in a r and omized trial of 300 adults scheduled for elective surgery . A control st and ard brief stop-smoking intervention served as a comparator , with both interventions delivered by clinicians . The primary outcome was the use rate of a quitline accessed through a dedicated toll-free telephone number , with use defined as completing at least one full counseling session . Secondary outcomes included self-reported abstinence from cigarettes at 30 and 90 days postoperatively . Results : Subject characteristics were similar between the two groups . Records from the design ated quitline documented that 29 of 149 subjects ( 19.5 % ) in the quitline intervention group and 0 of 151 subjects in the control group completed the first full counseling session ( P < 0.0001 ) . There were no significant differences in the self-reported point-prevalent and continuous abstinence rates between groups at either 30 or 90 days postoperatively , although rates tended to be higher in the quitline intervention group . Conclusions : Clinicians can effectively facilitate  quitline use by surgical patients . Further work is necessary to evaluate the efficacy of this approach in terms of long-term abstinence from cigarette smoking OBJECTIVE Brief preoperative abstinence from cigarette smoking reduces risk for perioperative complications in surgical patients . This study tested the hypothesis that the efficacy of brief advice recommending abstinence the morning of surgery would be increased if patients were informed that exhaled carbon monoxide ( CO ) levels would be monitored to assess compliance . METHOD Cigarette smokers scheduled for elective surgery were r and omized to 2 groups . Subjects in both groups received brief advice ( BA ) recommending smoking abstinence on the morning of surgery . The CO-informed + BA group was also told that their smoking status would be checked before surgery using exhaled CO monitoring ; the other group ( BA only ) was not . RESULTS CO levels on the morning of surgery were not significantly different in the CO-informed + BA ( n = 80 ) and BA-only groups ( n = 84 ; M = 9.7 , SD = 8.0 , and M = 9.3 , SD = 6.6 parts per million ( ppm ) , respectively , p = .67 ) . When the data from both groups were combined and compared with data from 506 additional surgical patients receiving only usual care , CO levels were significantly higher in those patients receiving usual care . CONCLUSIONS Informing patients that their smoking status would be checked the morning of surgery by CO monitoring does not further increase the efficacy of BA to abstain the morning of surgery Objective : To determine whether an intervention with smoking cessation starting 4 weeks before general and orthopedic surgery would reduce the frequency of postoperative complications . Summary Background Data : Complications are a major concern after elective surgery and smokers have an increased risk . There is insufficient evidence concerning how the duration of preoperative smoking intervention affects postoperative complications . Methods : A r and omized controlled trial , conducted between February 2004 and December 2006 at 4 university-affiliated hospitals in the Stockholm region , Sweden . The outcome assessment was blinded . The follow-up period for the primary outcome was 30 days . Eligibility criteria were active daily smokers , aged 18 to 79 years . Of the 238 patients assessed , 76 refused participating , and 117 men and women undergoing surgery for primary hernia repair , laparoscopic cholecystectomy , or a hip or knee prosthesis were enrolled . Intervention : Smoking cessation therapy with individual counseling and nicotine substitution started 4 weeks before surgery and continued 4 weeks postoperatively . The control group received st and ard care . The main outcome measure was frequency of any postoperative complication . Results : An intention-to-treat analysis showed that the overall complication rate in the control group was 41 % , and in the intervention group , it was 21 % ( P = 0.03 ) . Relative risk reduction for the primary outcome of any postoperative complication was 49 % and number needed to treat was 5 ( 95 % CI , 3–40 ) . An analysis per protocol showed that abstainers had fewer complications ( 15 % ) than those who continued to smoke or only reduced smoking ( 35 % ) , although this difference was not statistically significant . Conclusion : Perioperative smoking cessation seems to be an effective tool to reduce postoperative complications even if it is introduced as late as 4 weeks before surgery Background : Many surgical patients are dependent on nicotine . Smoke-free policies in healthcare facilities m and ate abstinence from smoking , which could contribute to psychological stress in the perioperative period . The authors tested the hypothesis that nicotine replacement therapy decreases psychological stress in cigarette smokers scheduled to undergo elective surgery and determined whether nicotine replacement therapy affects postoperative smoking behavior , even when not specifically prescribed to promote abstinence . Methods : In this double-blind , placebo-controlled trial , 121 smokers , of whom 116 received a study intervention , were r and omly assigned to receive either active ( nicotine-containing ) or placebo patches , beginning on the morning of surgery and continuing for up to 30 days after discharge from the hospital . Outcomes included the Perceived Stress Score , the Nicotine Withdrawal Score , and subject self-report of smoking behavior . Results : The Perceived Stress Score and the Nicotine Withdrawal Score did not change significantly from baseline over the immediate perioperative period and did not differ between active or placebo patch groups ( all P > 0.19 ) . The percentage of placebo versus active patch subjects reporting 7-day abstinence at 30 days postoperatively ( 30 % vs. 39 % ; P = 0.29 ) did not differ significantly between groups . At 30 days postoperatively , subjects in both groups significantly reduced their cigarettes smoked per day from baseline , but those receiving active patches reported a greater decrease ( a mean decrease of 11 ± 11 vs. 15 ± 7 cigarettes/day in placebo and active groups ; P = 0.045 ) . Conclusion : Routine nicotine replacement therapy is not indicated in smokers undergoing surgery for the purpose s of managing nicotine withdrawal and stress but can modify some aspects of postoperative smoking behavior BACKGROUND Smokers are more prone to develop postoperative complications . Smoking cessation intervention beginning 4 - 8 weeks prior to surgery improves the postoperative outcome . Cancer patients , however , often undergo surgery less than 4 weeks after diagnosis . The primary objective of this study was therefore to examine if a brief smoking cessation intervention shortly before breast cancer surgery would influence postoperative complications and smoking cessation . METHODS A r and omized controlled multicentre trial with blinded outcome assessment conducted at 3 hospitals in Denmark . One hundred and thirty patients were r and omly assigned to brief smoking intervention ( n = 65 ) or st and ard care ( n = 65 ) . The intervention followed the principles of motivational interviewing and included personalized nicotine replacement therapy aim ed at supporting smoking cessation from 2 days before to 10 days after surgery . RESULTS The overall postoperative complication rate ( including seroma requiring aspiration ) was 61 % in both groups risk ratio ( RR ) 1.00 ( 95 % CI 0.75 - 1.33 ) . The wound complication rate was 44 % versus 45 % . The effect on perioperative smoking cessation was modest , 28 % intervention versus 11 % control group patients , RR 2.49 ( 95 % CI 1.10 - 5.60 ) . There was no effect on smoking cessation at 12 months , 13 % versus 9 % . CONCLUSIONS Brief smoking intervention administered shortly before breast cancer surgery modestly increased self-reported perioperative smoking cessation without having any clinical impact on postoperative complications . The study adds to the body of evidence indicating that brief intervention has no clinical importance for surgical patients in regard to postoperative morbidity . Future studies should be design ed to determine the optimal time of smoking cessation before surgery Background : The efficacy of perioperative tobacco interventions on long-term abstinence and the safety of smoking cessation less than 4 weeks before surgery is unclear . Our objective was to determine the efficacy and safety of a perioperative smoking cessation intervention with varenicline to reduce smoking in elective surgical patients . Methods : In a prospect i ve , multicenter , double-blind , placebo-controlled trial , 286 patients were r and omized to receive varenicline or placebo .  Both groups received in-hospital and telephone counseling during 12 months . The primary outcome was the 7-day point prevalence abstinence rate 12 months after surgery . Secondary outcomes included abstinence at 3 and 6 months after surgery . Multivariable logistic regression was used to identify independent variables related to abstinence . Results : The 7-day point prevalence abstinence at 12 months for varenicline versus placebo was 36.4 % versus 25.2 % ( relative risk : 1.45 ; 95 % : CI : 1.01–2.07 ; P = 0.04 ) . At 3 and 6 months , the 7-day point prevalence abstinence was 43.7 % versus 31.9 % ( relative risk : 1.37 ; 95 % CI : 1.01 to 1.86 ; P = 0.04 ) , and 35.8 % versus 25.9 % ( relative risk : 1.43 ; 95 % : CI 1.01–2.04 ; P = 0.04 ) for varenicline versus placebo , respectively . Treatment with varenicline ( odds ratio : 1.76 ; 95 % CI : 1.03 
    Output:
    
Conclusions Published studies often inadequately described the methods for recruiting smokers into preoperative smoking cessation programmes .
Although smoking cessation at any time is beneficial , many programmes recruited smokers at times very close to scheduled surgery so that the benefit of preoperative smoking cessation may have not been fully effected .