By As a healthcare provider, you probably know that alcohol and nicotine use before surgery can result in a higher risk of complications. However, patients who are already anxious about having surgery may be reluctant to quit right before an operation. They may say that stopping makes them more anxious — and, they are probably correct. It is not uncommon for alcohol and nicotine users to experience anxiety when trying to stop.1Anxiety can lead to complications during and after surgery, such as pain and an increased risk of infection. So, is it worth getting patients to quit alcohol and tobacco use when it could further complicate things? The answer is yes.
The Enhanced Recovery After Surgery (ERAS®) guidelines suggest that patients stop alcohol and nicotine use before surgery.2The reasons for this are clear. Most of the time, poor surgery outcomes result from functional disability. Factors like alcohol and tobacco use, poor diet, and stress all contribute to prolonged healing periods and a greater risk of complications. 3
Two of the most significant lifestyle factors that result in poor surgical outcomes are tobacco and alcohol use. Patients who smoke have a clearly increased risk of complications both during and after surgery.4 Quitting alcohol and nicotine use one or two months before surgery can significantly lower the risk of complications. Danish researchers examined the results of 13 studies to determine what happens when people stop smoking before surgery. They found that people who stop smoking before surgery are much less likely to have wound healing problems after surgery.5
Patients who use alcohol before surgery are just as likely to suffer poor outcomes, such as pneumonia. Drinking alcohol seems to severely impair system functioning, which is very detrimental to recovery.6
How To Convince Patients To Quit
So, how can you get your patients to stop using alcohol or nicotine? Researchers at the University of Michigan recommend an approach that sports coaches take. Before a big game, coaches help athletes prepare to minimize the stress that they’ll undergo during the event. They might encourage marathon runners to replenish electrolytes as they run. Coaches also help athletes mentally prepare for a game by teaching them how to stay strong and manage stress. Preparing for surgery should be no different, say the researchers at the University of Michigan. They advocate that doctors act as more of a coach with patients.
This approach seems to work. Researchers at the University of Michigan conducted studies to measure how effective this approach is when it comes to preparing for surgery. The research study found that patients coached by their physicians went home two days earlier than those who were not. Also, 79 percent of smokers in the program were smoke-free at their post-op appointment.7 This approach is in line with Enhanced Recovery guidelines, as well. ERAS® stresses coaching and support for patients.
Do you want to try a similar approach with your patients? Here are some ways that you can do that.
#1 Empower Your Patient
Instead of lecturing your patient to stop smoking or drinking, empower them to quit. The Enhanced Recovery After Surgery protocol stresses the importance of patient empowerment. So, how can you help your patients feel empowered to take action? Many physicians still resort to lecturing. However, this is patronizing towards patients and does not result in empowerment. Instead of lecturing your patients, encourage them and support their efforts in taking a more active role in their outcome. Help them gain knowledge and confidence that they need to make healthy lifestyle choices. Educate your patients about the dangers of alcohol and nicotine use, and support healthy lifestyle changes — no matter how small. This will help them build confidence and feel enabled to quit.8
#2 Be A Partner
Another point that is stressed in the Enhanced Recovery protocol is the importance of patients as partners in their own health care. Once patients are committed to quitting, your job is to partner with them to make this happen. Once your patient has identified a plan to quit smoking or drinking alcohol, check in with them regularly to see how things are going. Keep an open line of communication going. Take a vested interest in your patient’s progress at quitting. Check in with them between appointments. Provide information that aligns with your patient’s goals. So, if you learn of a smoking cessation program that might be helpful for your patient, let them know about it and how they can enroll.
#3 Provide Tools To Help Them Quit
Provide resources to help your patients quit alcohol and nicotine use. If your medical practice offers evidence-based smoking cessation treatment, medications, or counseling, and the patient is a good candidate, then provide it. In most cases, tobacco dependence treatment is reimbursable by insurance companies.9
Use screening assessments to determine if your patient is dependent on nicotine or alcohol. Offer referrals to substance abuse treatment or smoking cessation resources if needed.9
#4 Try New Strategies
It is not uncommon for patients to struggle with giving up alcohol or tobacco. Many try multiple times before quitting. Therefore, encourage your patients not to give up. Tell them that every step is one step closer to quitting. Help them identify new strategies to quit if they fail. Maybe try a new medication or a new approach.
#5 Address Anxiety
Many patients feel increased levels of stress, tension, and anxiety right before surgery. It is a normal reaction to dealing with a major life event like surgery. Attempting to quit alcohol or tobacco use can amplify anxiety. Inversely, anxiety can trigger alcohol and nicotine use. Therefore, it is essential that you help patients manage anxiety. The first step is to look for signs of anxiety in your patient, such as:
- Panic
- Heart palpitations
- Shortness of breath
- Sleep disturbances
Ask about these symptoms. Listen to your patient’s concerns. Consider a referral to a mental health therapist for treatment. Therapy can help patients learn to better manage anxiety, which can result in better surgical outcomes.
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