England - smokers blocked from routine surgery as cost-cutting measure..

December 15, 2010 - All smokers awaiting non-life threatening elective surgery - which includes hip and knee operations - must take the 12 week smoking cessation course offered by the NHS Stop Smoking Service. It is one of a range of measures being taken by managers at the primary care trust (PCT), which serves 675,000 people, to cut costs.

Dr. Steven Bodley, Chair of Ontario's Anesthesiologists at the Ontario Medical Association (OMA). "We know that patients who stop smoking before surgery not only reduce their risk of complications, but also speed up their recovery time. Patients that recover more quickly spend less time in hospital and can free up space, saving much needed health care dollars that can be reinvested back into patient care."

Other benefits to patients who stop smoking before surgery include:
- 48% of smokers experienced breathing problems after surgery, compared to 17% of smokers who had quit more than 8 weeks before surgery. (Warner et al. Anesthesiology 1984; 60:380-383);
- Overall complication rates for smokers vs. quitters drop from 52% to 18% (Moller et al. The Lancet 2002 Jan :114-117); and
- Wound infection rates for smokers vs. non-smokers drop from 12% to 2% (Sorensen et al. Annals of Surgery 2003 July:1-5).

We want patients who smoke to know the proactive steps they can take to improve their surgical experience," said Dr. Bodley. (Stopping Smoking Before Surgery Could Save Millions: Ontario's , Ontario Medical Association News Release, 1/2010)
Another measure includes requiring those who are seriously overweight, with a body mass index (BMI) or 30 or more, to go on a 12-week NHS weight loss programme.

The orders, outlined in a letter to General Practitioners (GPs) from the PCT, went into force earlier this month. The letter read: "There is good evidence to show that stopping smoking prior to surgery reduces length of stay and infection rates, and improves healing time; it is also a time when people are often highly motivated to give up.

"All patients who smoke and are booked for planned surgery will therefore be required to complete a NHS Stop Smoking course prior to surgery." A spokesman for NHS Kent confirmed the measures were designed to curb a potential overspend of up to £10 million, or one per cent of its budget, by April 2011. She said: "They are part of a range of measure to ease the financial pressures that we are experiencing."

A fifth of patients in the health authority's area smoke while a quarter are overweight.

Under the NHS Constitution all patients should receive treatment within 18 weeks of referral, although the Coalition recently removed this as a target. However, NHS rules allow health authorities to "stop the clock" while patients go on such courses.

Dr John Allingham, medical secretary of Kent Local Medical Committee, told the GPs' magazine Pulse that doctors were strongly opposed to the orders. He said: "It's a way of extending the waiting times."

Reference: Smokers told: stop before your hip operation A health authority has ordered smokers to take a stop smoking course before they can have an operation, in a move designed to save cash as budgets tighten by Stephen Adams, Medical Correspondent, The Telegraph, 12/13/2010.