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Table 1 Methods used in the included studies to identify and recruit smokers for preoperative smoking cessation

From: Identifying and recruiting smokers for preoperative smoking cessation—a systematic review of methods reported in published studies

Study: author year (country) Surgery: no. of smokers (recruitment rate) Recruiting method How (and when) recruited before surgery Target quit period before surgery
Randomised controlled trials (RCTs)
 Andrews et al. 2006 [10]a (UK) Elective surgery 102 (NA) At the routine 4 weeks preoperative appointment, a nurse asked all patientswho smoked if they would be interested in the trial. If patients were interested, a researcher asked patients to sign a consent form. Preoperative clinic
(about 4 weeks)
1–2 weeks
 Glasgow et al. 2008 [11] (USA) Multiple procedures 391 (36.8 %) Smokers about to undergo surgery or diagnostic procedure were identified usingelectronic medical records system and received a personalised introductory letter about the study from the chief of preventive medicine (with an “opt-out” postcard). 1–2 weeks prior to procedure date, trained telephone interviewers contacted smoking patients who did not decline via postcard. Screening of electronic medical records
(1–2 weeks)
Smoking reduction 1–2 weeks before surgery
 Lee et al. 2013 [12] (Canada) Elective surgery 168 (43.0 %) Patients scheduled for elective surgery having a pre-admission clinic appointment at least 3 weeks before surgery were screened using a questionnaire for smoking status. The researchers’ interaction included informed consent. Nurses in the pre-admission clinic randomised participants to groups on the day of enrolment. Pre-admission clinic (anaesthesia)
(≥3 weeks: median 24 days, range 22 to 31)
≥1 week
 Lindstrom et al. 2008 [13] (Sweden) General or orthopaedic 117 (58.2 %) Participants were enrolled by study nurses or by the treating surgeons >4 weeks prior to surgery. 586 were planned to be recruited, but the trial was stopped early due to a low rate of recruitment and a high refusal rate (with only 117 smokers recruited). Not explicitly reported
(≥4 weeks)
4 weeks
 McHugh et al. 2001 [14] (UK) Coronary artery bypass surgery 121 (85.0 %) Consecutive patients were identified within 1 month as they were added to the waiting list. Patient’s GPs were contacted by letter for consent of their patients to be recruited to the study. Unclear about who identified and recruited smokers. The mean (SD) waiting time was about 8.4 (2.7) months. At the time of waiting list placement
(mean waiting time 8.4 months, SD 2.7)
 Moller et al. 2002 [15]a (Denmark) Hip and knee replacement 120 (72.3 %) Daily smokers scheduled for primary elective hip or knee alloplasty were recruited 6–8 weeks before scheduled surgery. A project nurse explained the study detail to patients. Preoperative clinic
(6–8 weeks)
6–8 weeksa
 Myles et al. 2004 [16]a (Australia) Elective surgery 47 (10.7 %a) Research staff screened the elective surgery waiting list to identify smokers expected to undergo surgery within an 8–14-week timeframe and asked potentially eligible participants to contact research staff for further details. (The original protocol was to investigate smoking cessation at the time of hospital admission for surgery, but the study protocol was revised due to a low rate of recruitment and a high dropout rate.) Screening of waiting list
(8–14 weeks: median 120 days, IQR 60 to 120)
About 28 daysa
 Ostroff et al. 2013 [17] (USA) Cancer surgery 185 (70.1 %) Participants with newly diagnosed cancer scheduled for surgery (>7 days from study entry) were screened via the electronic medical record and recruited from surgical clinics, by a trained research assistant. Screening of electronic medical records
(≥1 week)
>1 day before inpatient admission
 Ratner et al. 2004 [18] (Canada) Elective surgery 237 (56.7 %) Patients admitted for pre-surgical assessment (1–3 weeks before surgery) were screened for eligibility by registered nurses. Preoperative clinic
(1–3 weeks)
>1 day before surgery
 Shi et al. 2013 [19]a (USA) Elective surgery 169 (92.3 %a) As part of routine preoperative evaluation (POE), patients provide information on smoking behaviour. The median time from study assessment at POE to surgery was 1 day (IQR 1 to 3). Smokers were identified by clinical POE personnel on a convenience basis. Consent by study personnel was obtained after study procedures were completed. Preoperative clinic (anaesthesia)
(median 1 day; IQR 1 to 3)
<1 day (on the day of surgery)
 Sorensen et al. 2007 [20] (Denmark) Herniotomy 180 (90.9 %) Smokers scheduled for elective open incisional or inguinal day-case herniotomy were included (about 3 months before surgery). Recruiting method was not described, although the involvement of a study nurse was mentioned. Not explicitly reported
(about 3 months)
>4 weeks
 Sorensen and Jorgensen 2003 [21] (Denmark) Open colorectal 60 (74.1 %) At the time of diagnosis and selection of operative procedure, patients who smoked daily and were scheduled for an open colonic or rectal surgery were included. The study was originally planned as a 5-centre trial of 300 smokers. Four centres failed to enrol participants after initiation, and recruitment was continued at the remaining centre until an equal number of participants in both groups were enrolled (n = 60). Unclear about how smokers were identified and recruited. Not explicitly reported
(>2–3 weeks)
2–3 weeks
 Thomsen et al. 2010 [22] (Denmark) Breast cancer 130 (50.2 %) Women scheduled for breast surgery were included (3–7 days before surgery). Methods for identifying and recruiting smokers were unclear. Not explicitly reported
(3–7 days)
>2 days
 Warner et al. 2011 [23]a (USA) Elective surgery 300 (68.5 %) Current smokers were recruited from the preoperative evaluation clinic in preparation for surgery on a convenience basis. Recruitment occurred when appropriate research and clinical personnel were available. Time from preoperative evaluation to surgery: median 1 day, IQR 1–4 days. Preoperative clinic (anaesthesia)
(median 1 day; IQR 1 to 4 days)
About 1 day
 Warner et al. 2005 [24] (USA) Elective surgery 121 (9.1 %) Smokers were recruited from patients evaluated at the preoperative evaluation in preparation for surgery. Preoperative clinic (anaesthesia)
(<1 week)
About 1 day
 Warner and Kadimpati 2012 [25]a (USA) Elective surgery 46 (52 %a) Current smokers were recruited from the preoperative evaluation clinic in preparation for surgery on a convenience basis. Preoperative clinic (anaesthesia)
(<1 week)
About 1 day
 Wolfenden et al. 2005 [26] (Australia) Non-cardiac elective surgery 210 (82.4 %) Patients at high risk were booked to attend a non-cardiac preoperative clinic 1–2 weeks before their scheduled procedure. Participants completed a computerised assessment, and those identifying themselves as smokers were recruited by a research assistant. Preoperative clinic
(1–2 weeks)
>1 day before admission
 Wong et al. 2012 [27]a (Canada) Elective non-cardiac surgery 286 (29.6 %) All adult patients at the preoperative clinics scheduled for elective non-cardiac surgery were screened. Smoking patients scheduled for surgery (8–30 days before the scheduled surgery), who met the eligibility criteria were recruited. Preoperative clinic
(1–4 weeks)
>1 day
Non-randomised studies (NRS)
 Backer et al. 2007 [28] (Denmark) Acute orthopaedic surgery 121 (60.5 %) On the day of admission, patients admitted to acute orthopaedic wards on weekdays were routinely asked about smoking habits as part of their medical history, and a trained nurse provided a motivational counselling. A specially trained nurse in the morning briefing reviewed medical files to ensure that smokers could be contacted. On the day of admission
(about 1 day)
<1 day
 Browning et al. 2000 [29]a (USA) Lung cancer surgery 25 (100 %) Researchers recruited potential participants from a lung cancer surgery clinic’s new patient schedule, during the first clinical consultation. The participant set a quit date for 14 days later. Preoperative clinic (first clinical consultation)
 Haddock and Burrows 1997 [30] (UK) General or gynaecology day surgery 60 (100 %) A research nurse implemented smoking cessation programme in surgical pre-admission clinics (7–14 days before surgery). Smokers who were willing to participate were eligible for the study. Preoperative clinic
(1–2 weeks)
 Haile et al. 2002 [31] (Australia) Non-cardiac surgery 56 (100 %) Prior to booking in for surgery, all patients were given a surgical risk assessment by their GP, surgeon, or pre-admission staff. Patients at high risk were required to attend the pre-admission clinic 2 weeks prior to surgery, and a research assistant determined eligibility. Preoperative clinic
(2 weeks)
<2 weeks
 Kozower et al. 2010 [32]a (USA) Thoracic surgery 23 (66.7 %) Recruiting method was not reported. Included preoperative (23), postoperative (11), and follow-up smokers (6). A clinical research coordinator was present to facilitate the study. Preoperative clinic
(typically 3 weeksa)
2 weeksa
 Kunzel et al. 2012 [33] (USA) Urologic 38 (NA) Preoperatively (the mean interval to day of surgery was 25 days, median 11, range 1–131 days). Recruiting method was not reported, although urologists and research staff performed the intervention. Preoperative clinic
(median 11 days; range 1 to 131 days)
 Moore et al. 2005 [34] (USA) Urogynaecology surgery 233 (NA) On their initial history and physical examinations, patients who admitted to smoking were recruited (>1 month prior to surgery). Unclear about how smokers were identified. Not explicitly reported
(≥4 weeks)
4 weeks
 Munday et al. 1993 [35] (UK) Elective surgery 233 (NA) At the time of outpatient consultation (>6 weeks prior to surgery), smokers were identified and the hospital notes were marked to enable the smokers to be identified when admitted to hospital. Control smokers were participants admitted from the waiting list for elective surgery who smoked but had not been given specific advice to stop. Unclear about who identified and recruited smokers. Preoperative clinic
(>6 weeks)
≥6 weeks
 Sachs et al. 2012 [36]a (Canada) Elective surgery (excluding CVD and neurosurgery and plastic) 714 (20 %a) At pre-admission clinic, registration clerks identified patients who were current smokers and informed them about the programme. Eligible participants were asked by research staff if they would be willing to participate in the evaluation study. Preoperative clinic
 Shah et al. 1984 [37] (UK) Elective surgery 200 (NA) In the intervention group a letter was sent with the admission note to all patients; non-smokers were asked to disregard the letter. In the control group, recruitment occurred on the day of the operation after recovery. Unclear about how smokers were identified and recruited. Not explicitly reported
5 days
 Tonnesen et al. 2010 [38]a (Denmark) Elective surgery 57 (12.3 %) GP (199) were invited to identify daily smoking when referring them to surgery and to refer high-risk patients to a preoperative risk reduction programme. However, only 2 patients were referred a few months after starting the programme, and additional efforts slightly increased referral to the programme (7/72). High-risk patients for elective surgery were also identified at the department of orthopaedic surgery and surgical gastroenterology (at their first contact to hospitala). At the time of GP referral
(about 6 weeksa)
About 6 weeksa
 Walker et al. 2009 [39] (UK) Forefoot surgery 25 (100 %) Senior author (based at the Orthopaedic Department) reviewed all patients prior to planned surgery (approximately 6 months prior to planned surgery). Screening of medical records
(about 6 months)
 Webb et al. 2014 [40] (Australia) Non-obstetric elective surgery 347 (99.1 %) Printed quit-pack was sent to all adult patients (including smokers) at the time of waiting list placement for non-obstetric elective surgery. Help from waiting list staff was acknowledged. At the time of waiting list placement
(>4 weeks)
≥4 weeks
 Wheatley et al. 1977 [41] (Australia) Inguinal hernia repair 15 (NA) Patients (15 smokers and 15 non-smokers) were assigned arbitrarily to one of three groups. Recruiting methods not reported. Not explicitly reported
5 days
  1. Recruitment rate was calculated using the number of smokers recruited as numerator and the number of invited eligible smokers as denominator. Target quit period before surgery was based on recommended quit date, not necessarily reflect the actual quit period preoperatively
  2. NA not available, SD standard deviation, POE preoperative evaluation, GP general practitioner, CVD cardiovascular diseases, IQR interquartile range, USA United States of America
  3. aAuthors of the studies responded to request for additional information. We were able to contact authors of 14 studies by emails and received response from authors of ten studies with some additional information on missing or unclear data