Defiant smokers asked to sign waivers before routine surgery

SMOKERS are facing pressure to give up the habit before undergoing routine surgery in a new initiative by family doctors in Yorkshire.
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The Stop Before Your Op programme is being introduced in the Vale of York in the first part of a major campaign by the local NHS to tackle harm from tobacco, alcohol and obesity. Smokers will be urged to go on a NHS course to help them quit before going under the knife in routine operations, leaving them facing a minimum 12-week delay before they are referred for surgery.

Doctors’ leaders say patients will not be denied surgery if they refuse but will be asked to sign waivers saying they “accept responsibility for any additional detriment to their health including complications arising from surgery or anaesthesia attributed to their smoking”.

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GPs say they are monitoring outcomes from smokers referred for help to quit to assess the success of the venture. They point to significant benefits from giving up smoking prior to surgery, among them reducing the risk of complications and improving post-operative recovery.

They claim the measure could also lead to savings for the NHS by reducing demand on intensive care, readmissions for further treatment and pressure on hospital beds. It is likely to affect about four in every 1,000 GP patients each year at 33 practices in the area, which covers York, Selby, Tadcaster, Easingwold, Pocklington and parts of Ryedale.

All smokers referred for planned surgery, except those requiring urgent hospital appointments for problems including suspected cancer and those with mental health problems, will fall under the initiative.

In a statement, the Vale of York Clinical Commissioning Group said it gave patients the opportunity to improve their recovery from surgery and help them make a “potentially life-changing decision that will improve their health and wellbeing”.

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“Patients who decide not to quit will not be denied surgery, nor would this prevent a referral to progress to an elective procedure,” said a spokesman. “Those who do not agree to stop smoking are required to sign a waiver to confirm they understand the risks associated with smoking and how this may impact on their recovery.”

In guidance for NHS staff, chief clinical officer Mark Hayes, a GP in Tadcaster, says the referral delay of at least 12 weeks would allow patients to attend standard four-six week quit programmes and allow time for benefits of stopping smoking to take effect.

If a doctor believed the risks of delaying surgery exceeded the risk from smoking, patients should be referred for treatment.

“Patients are not at any point denied surgery. The policy promotes smoking cessation treatment as part of the patient journey to reduce the serious risks associated with surgery for smokers,” he said.

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Patients would be asked to sign waivers if they found the intervention programme was “socially or medically unacceptable to them”. Those who did quit would have tests to verify their claims. Patients who were unsuccessful would be asked to try again if their clinical need was not urgent.

About 17 per cent of people smoke in the York area, lower than the English average of 20 per cent. It is the leading cause of preventable illness and death and smoking cessation is said to be the most cost-effective medical intervention other than immunisation.

Benefits from quitting before surgery are said to include improved wound healing and a reduced risk of chest infections, as well as lessening problems related to general anaesthesia. Evidence suggests one in three smokers suffer breathing problems after an operation but this falls dramatically to one in 10 if they give up at least eight weeks before.

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