“Stop Before the Op: The short-term benefits of preoperative smoking cessation in London ” Dr Bobbie Jacobson OBE Director www.lho.org.uk.
Download ReportTranscript “Stop Before the Op: The short-term benefits of preoperative smoking cessation in London ” Dr Bobbie Jacobson OBE Director www.lho.org.uk.
“Stop Before the Op: The short-term benefits of preoperative smoking cessation in London ” Dr Bobbie Jacobson OBE Director www.lho.org.uk 1 Pre-Operative Smoking Cessation: The Context Integral part of Delivery Plan for “Choosing Health” Unique Opportunity to influence patients and their families Smoking in London is responsible for: – £120,000 avoidable hospital admissions a day – 11,000 bed days pa – Costs London’s NHS £105 million pa 2 Who Made this Work Possible? 3 Carole Furlong and Barnet/Hounslow PCTs LHO Smokefree London What is the Evidence that Smoking before Surgery is Harmful? 4 Increased risk of lung, heart and infectious complications Impaired wound-healing Reduced bone fusion after fracture Increased risk of dying in hospital Increased length of hospital stay Smoking & Elective Surgery: The Harms vs Benefits Balance Sheet Short Term Benefits Short Term Risks Reduction in lung Risk of lung & heart complications complications up to 4 weeks+ before op Faster wound healing Faster bone fusion time Reduced length of hospital stay 5 Long Term Benefits Reduction in risk of CHD lung & other cancers & premature death Modelling the Impact of Improved Stop Smoking Services for Pre-Op Patients Assumptions 6 Numbers of smokers admitted for elective surgery Numbers likely to quit (10% conservative estimate, 30% optimistic) Numbers of post op complications Numbers of bed days/potential cost savings Estimated Number of Smokers Admitted for Elective Surgery from London PCTs Number who would stop smoking PCT Total current smokers admitted for elective surgery Conservative estimate Optimistic estimate Sutton & Merton 8990 724 1510 Ealing 7655 616 1286 Bromley 7535 607 1266 Enfield 7429 598 1248 Greenwich 7339 591 1233 Lewisham 7192 579 1208 Newham 6964 561 1170 Lambeth 6964 561 1170 Barnet 6567 529 1103 Hillingdon 6276 505 1054 Brent 6266 504 1053 Havering 6099 491 1025 Bexley 5987 482 1006 Croydon 5908 476 993 City & Hackney 5903 475 992 Waltham Forest 5840 470 981 7 Estimated Number of Smokers Admitted for Elective Surgery from London PCTs Number who would stop smoking PCT Total current smokers admitted for elective surgery Conservative estimate Optimistic estimate Barking & Dagenham 5826 469 979 Wandsworth 5724 461 962 Southwark 5719 460 961 Hounslow 5674 457 953 Redbridge 5560 448 934 Tower Hamlets 5540 446 931 Haringey 5379 433 904 Westminster 5260 423 884 Hammersmith & Fulham 4856 391 816 Camden 4716 380 792 Islington 4002 322 672 Kensington & Chelsea 3895 314 654 Harrow 3849 310 647 Richmond & Twickenham 3352 270 563 Kingston 3017 243 507 Total for all London PCTs 181,283 14,596 30,457 8 Numbers of complications that could be prevented by stopping smoking All complications PCT Estimated number of all complications in smokers Conservative estimate for stopping smoking Optimistic estimate for stopping smoking Sutton & Merton 4675 128 267 Ealing 3980 109 227 Bromley 3918 107 224 Enfield 3863 106 221 Greenwich 3816 104 218 Lewisham 3740 102 214 Newham 3621 99 207 Lambeth 3621 99 207 Barnet 3415 93 195 Brent 3259 89 186 Hillingdon 3263 89 186 Havering 3172 87 181 Bexley 3113 85 178 City & Hackney 3070 84 175 Croydon 3072 84 175 Barking & Dagenham 3030 83 173 Waltham Forest 3037 83 173 9 Numbers of complications that could be prevented by stopping smoking All complications PCT Estimated number of all complications in smokers Conservative estimate for stopping smoking Optimistic estimate for stopping smoking Wandsworth 2976 81 170 Southwark 2974 81 170 Hounslow 2951 81 169 Tower Hamlets 2881 79 165 Redbridge 2891 79 165 Haringey 2797 77 160 Westminster 2735 75 156 Hammersmith & Fulham 2525 69 144 Camden 2452 67 140 Islington 2081 57 119 Kensington & Chelsea 2025 55 116 Harrow 2002 55 114 Richmond & Twickenham 1743 48 100 Kingston 1569 43 90 94,267 2578 5,385 10 Total for all London PCTs Bed Days Saved by Stopping Smoking Bed days saved by stopping smoking PCT 11 Conservative estimate for stopping smoking Mean estimate for stopping smoking Optimistic estimate for stopping smoking Sutton & Merton 85 132 178 Ealing 74 115 155 Lewisham 72 111 150 Lambeth 72 111 150 Croydon 69 106 143 Enfield 66 102 138 Barnet 65 100 135 Bromley 63 97 131 Brent 62 96 129 Hillingdon 62 96 129 Greenwich 61 95 128 Wandsworth 60 93 126 Southwark 58 89 120 Bexley 57 89 120 Camden 57 89 120 Hounslow 57 88 118 Bed Days Saved by Stopping Smoking Bed days saved by stopping smoking PCT 12 Conservative estimate for stopping smoking Mean estimate for stopping smoking Optimistic estimate for stopping smoking Westminster 55 85 114 Haringey 53 82 111 City & Hackney 52 80 108 Havering 50 77 105 Barking & Dagenham 49 76 103 Tower Hamlets 49 76 102 Newham 48 74 100 Hammersmith & Fulham 48 74 100 Islington 47 72 97 Waltham Forest 46 71 95 Redbridge 44 68 92 Harrow 38 59 79 Kensington & Chelsea 36 56 76 Richmond & Twickenham 36 56 76 Kingston 29 46 62 Total for London 1,720 2,655 3,590 Questions for Implementation 13 What service design changes are needed in surgical OPD to be able to deliver a one stop smoking cessation service? How can such a service ensure that cessation advice is given at the right time? Who should lead the OPD intervention? How can the PCT smoking cessation team support the development of the service? How can we ensure that smoking cessation requirements are part of the specification for surgical care? The Size of the Opportunity for Londoners Costs Avoided: Up to £1.15 million for PCTs Up to £2.8 million for Trusts Current Smokers Admitted for Surgery(PCTs) 181,300 Numbers of post-op complications 5300 potentially preventable 14 Potential number of Quitters 30,400 Bed Days saved 3600 Further Information? 15 Further copies of “Stop before the Op” can be downloaded from www.lho.org.uk Copies of the technical report “Preoperative Smoking Cessation: a model to estimate potential short-term health gain and reductions in length of stay, Carole Furlong, Sep 05” can also be downloaded from www.lho.org.uk Have you registered with www.lho.org.uk ?