A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement.

I n t e r v e n t i o n At 6 to 8 weeks before surgery, 60 patients were allocated to the smoking intervention and were offered a weekly meeting with the project nurse. At the first meeting, a Fagerstöm test was done to estimate the patient’s nicotine dependence. Test results and patient preference were used to devise a personalized nicotine substitution schedule. Patients were strongly encouraged to stop smoking, but they also had the option to reduce tobacco consumption by ≥ 50%. Smoking status was monitored, and nicotine substitution products were provided free of charge. At subsequent meetings, tobacco use was recorded, and patients were given advice about smoking cessation or reduction, benefits and side effects, and management of withdrawal symptoms and weight gain. 60 patients were allocated to usual care (little or no information or counseling on smoking).