***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 BACKGROUND An association between smoking and impaired wound healing has been reported in retrospective studies . The smoking status of a surgical patient may be confounded by social and medical parameters . We have evaluated the effect of smoking in a test wound in volunteers , with special reference to a reliable scientific match between smokers and nonsmokers . METHODS In a prospect i ve open study with blinded assessment , 19 smoking ( 20 cigarettes/day ) and 18 nonsmoking healthy volunteers were matched with respect to baseline characteristics . The deposition of total protein and mature collagen ( expressed as hydroxyproline ) was assessed in an exp and ed polytetrafluoroethylene wound healing model implanted subcutaneously for 10 days . RESULTS The nonsmokers had a 1.8 times higher median amount of hydroxyproline than the smokers ( p < 0.01 ) . The deposition of hydroxyproline was negatively correlated with the consumption of tobacco both before ( r = -0.44 ; p < 0.01 ) and during the study ( r = -0.48 ; p < 0.005 ) . The impairment was specific for the production of collagenous proteins and not other proteins . CONCLUSIONS The synthesis of subcutaneous collagen in smokers is specifically impeded , indicating an impaired wound-healing process . Because mature collagen is the main determinator of strength of an operative wound , the results support the view that patients should be advised to stop smoking before an operation 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 Although it is now generally accepted that patients should be advised to quit smoking before surgery , the effect of low-intensive smoking cessation intervention , both on preoperative smoking behavior and on risk reduction , remains unclear . Our objective was to study the effect on perioperative smoking behavior and on postoperative wound infection of different types of low-intensive intervention before herniotomy . Methods Between October 1998 and October 2000 , 180 consecutive smokers scheduled for elective herniotomy were advised to quit smoking perioperatively and subsequently allocated r and omly to three low-intensive smoking cessation groups : a st and ard ( control ) group , a telephone group , which was reminded by telephone , and an out-patient group , which was reminded by means of an out-patient talk and demonstration of nicotine replacement drugs . Spontaneous perioperative smoking behavior was recorded for 64 consecutive non-advised smokers . Postoperative wound infection was evaluated by independent assessors . Results Of the advised patients , 19 % ( 29/149 ) stopped smoking before surgery compared with 2 % ( 1/64 ) in the non-advised cohort ( P < 0.01 ) . In the st and ard group 13 % ( 6/48 ) quit smoking compared with 23 % ( 23/101 ) in the pooled telephone and outpatient group ( NS ) . In the last group 64 % ( 65/101 ) reduced or stopped smoking compared with 42 % ( 20/48 ) in the st and ard group ( P < 0.05 ) . Predictors of failed perioperative cessation of smoking were a CO breath-test at inclusion above 20 ppm ( OR : 0.11 ; 0.02–0 - 57 ) and low motivation to quit smoking ( OR : 0.25 ; 0.09–0.70 ) . Wound infection occurred in 6 % ( 13/213 ) and there was no difference between the groups . Conclusion Low-intensive smoking cessation intervention helps approximately one fifth of patients to stop smoking perioperatively . Patients who are reminded in addition to preoperative advice are more likely to stop or reduce smoking . Failure to stop smoking is greater if the patients are not motivated and if the CO breath test is high at the time of the preoperative advice Abstract Objective : To evaluate a  smoking cessation intervention that can be routinely delivered to smokers admitted with cardiac problems . Design : R and omised controlled trial of usual care compared with intervention delivered on hospital wards by cardiac rehabilitation nurses . Setting : Inpatient wards in 17 hospitals in Engl and . Participants : 540 smokers admitted to hospital after myocardial infa rct ion or for cardiac bypass surgery who expressed interest in stopping smoking . Intervention : Brief verbal advice and st and ard booklet ( usual care ) . Intervention lasting 20 - 30 minutes including carbon monoxide reading , special booklet , quiz , contact with other people giving up , declaration of commitment to give up , sticker in patient 's notes ( intervention group ) . Main outcome measures : Continuous abstinence at six weeks and 12 months determined by self report and by biochemical validation at these end points . Feasibility of the intervention and delivery of its components . Results : After six weeks 151 ( 59 % ) and 159 ( 60 % ) patients remained abstinent in the control and intervention group , respectively ( P=0.84 ) . After 12 months the figures were 102 ( 41 % ) and 94 ( 37 % ) ( P=0.40 ) . Recruitment was slow , and delivery of the intervention was inconsistent , raising concerns about the feasibility of the intervention within routine care . Patients who received the declaration of commitment component were almost twice as likely to remain abstinent than those who did not receive it ( P<0.01 ) . Low dependence on tobacco and high motivation to give up were the main independent predictors of positive outcome . Patients who had had bypass surgery were over twice as likely to return to smoking as patients who had had a myocardial infa rct ion . Conclusions : Single session interventions delivered within routine care may have insufficient power to influence highly dependent smokers . What is already known on this topic Stopping smoking after a serious cardiac event is associated with a significant decrease in mortality Up to 70 % of smokers who survive cardiac surgery smoke again within a year Intensive interventions delivered by dedicated staff can help cardiac patients not to start to smoke again What this study adds An intervention delivered by cardiac rehabilitation nurses within routine care during patients ' hospital stay failed to increase the number who managed to stop smoking in the long term For busy staff with competing priorities , the 30 minute intervention was also on the borderline of practicability Patients admitted after a myocardial infa rct ion were over twice as likely to give up than those admitted for a bypass BACKGROUND Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers . Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement . METHODS We did a r and omised trial in three hospitals in Denmark . 120 patients were r and omly assigned 6 - 8 weeks before scheduled surgery to either the  control ( n=60 ) or smoking intervention ( 60 ) group .  Smoking intervention was counselling and nicotine replacement therapy , and either smoking cessation or at least 50 % smoking reduction . An assessor , who was masked to the intervention , registered the occurrence of cardiopulmonary , renal , neurological , or surgical complications and duration of hospital admittance . The main analysis was by intention to treat . FINDINGS Eight controls and four patients from the intervention group were excluded from the final analysis because their operations were either postponed or cancelled . Thus , 52 and 56 patients , respectively , were analysed for outcome . The overall complication rate was 18 % in the smoking intervention group and 52 % in controls ( p=0.0003 ) . The most significant effects of intervention were seen for wound-related complications ( 5 % vs 31 % , p=0.001 ) , cardiovascular complications ( 0 % vs 10 % , p=0.08 ) , and secondary surgery ( 4 % vs 15 % , p=0.07 ) . The median length of stay was 11 days ( range 7 - 55 ) in the intervention group and 13 days ( 8 - 65 ) in the control group . INTERPRETATION An effective smoking intervention programme 6 - 8 weeks before surgery reduces postoperative morbidity , and we recommend , on the basis of our results , this programme be adopted We assessed the efficacy of a comprehensive programme for stopping smoking in 210 smokers scheduled for surgery , before admission and 3 months after attending a pre‐operative clinic . Participants were r and omly allocated to receive an intervention incorporating nicotine replacement therapy for patients smoking more than 10 cigarettes per day ( ‘ dependent smokers ’ ) , or to a control group to receive usual care .  Dependent smokers allocated to the intervention group were more likely to report abstinence before surgery than those allocated to receive usual‐care ( 63 ( 73 % ) vs. 29 ( 56 % ) , respectively ; OR 2.2 ( 95 % CI 1.0–4.8 ) ) , and 3 months after attendance ( 16 ( 18 % ) vs. 3 ( 5 % ) , respectively ; OR = 3.9 ( 95 % CI 1.0–21.7 ) OBJECTIVE To examine the effect of a nurse-delivered smoking cessation intervention on short-term smoking abstinence among hospitalized postoperative patients . DESIGN Prospect i ve , experimental , r and om assignment . SETTING Midwestern university-affiliated tertiary medical center . PATIENTS Postoperative smokers ( n = 80 ) from cardiovascular , oncology , and general surgical units . OUTCOME MEASURE Self-reported smoking status and saliva cotinine level at 5 to 6 weeks after hospitalization . INTERVENTION Three structured smoking cessation sessions during hospitalization , followed by phone calls once a week for 5 weeks after discharge . RESULTS Of the experimental group patients , 37.8 % were abstinent as compared to 25.6 % in the usual care group . Abstinence rates of experimental group patients from cardiovascular ( 40 % ) and oncology ( 64.3 % ) units were higher than that of GS ( 13.3 % ) unit patients . Regardless of group assignment , 100 % of cardiovascular and oncology patients abstained during hospitalization , compared to only 10.7 % of GS patients . CONCLUSIONS Preliminary results indicate that a nurse-delivered cessation intervention may be effective postoperatively among smokers with an identified smoking-related diagnosis PURPOSE Nicotine replacement therapy has become a popular therapy for smokers attempting to stop smoking . Unfortunately , some subjects continue to smoke while receiving it . Since nicotine is believed to be the primary constituent of cigarette smoke responsible for its acute adverse effects on myocardial oxygen supply and dem and , concomitant nicotine replacement therapy and smoking theoretically could provoke a marked decrease in myocardial oxygen supply and increase in dem and . This study was performed to assess the effects of cigarette smoking with and without concomitant intranasal nicotine spray on : ( a ) myocardial oxygen dem and , ( b ) coronary arterial dimensions , and ( c ) the development of acute cardiovascular tolerance . PATIENTS AND METHODS In 19 smokers 
    Output:
    
Preoperative smoking interventions are effective for changing smoking behaviour perioperatively .
The impact on complications may depend on how long before surgery the smoking behaviour is changed , whether smoking is reduced or stopped completely , and the type of surgery