From the Guidelines
It is not recommended to start using a nicotine patch before inpatient surgery without first considering the potential risks and benefits, as recent guidelines suggest delaying surgery to achieve nicotine cessation or decreased use of nicotine products may be beneficial for patients undergoing total joint arthroplasty 1. When considering nicotine replacement therapy before surgery, it's essential to weigh the potential benefits of reducing withdrawal symptoms against the potential risks of nicotine use on surgical outcomes.
- Nicotine patches can help manage nicotine cravings and prevent withdrawal symptoms during hospitalization, but they may also affect blood pressure and heart rate, which needs to be monitored by the surgical team.
- The optimal timing and duration of nicotine replacement therapy before surgery are unclear, but stopping nicotine use at least 4 weeks before surgery is recommended to reduce the risk of postoperative complications, such as respiratory and wound-healing complications 1.
- For patients who are heavy smokers, discussing nicotine replacement therapy with their healthcare provider before surgery is crucial to determine the best course of treatment and minimize potential risks 1.
- The use of nicotine patches before surgery should be individualized, taking into account the patient's overall health, smoking history, and surgical risks, and should be guided by the most recent and highest-quality evidence available 1.
From the Research
Nicotine Patch Use Before Surgery
- The use of nicotine replacement therapy (NRT), including nicotine patches, before surgery is a topic of interest for smoking cessation and its potential impact on surgical outcomes 2, 3, 4, 5, 6.
- Studies have shown that NRT can be effective in achieving long-term smoking abstinence, with high-certainty evidence supporting the use of combination NRT (fast-acting form + patch) over single-form NRT 2, 4.
- There is moderate-certainty evidence that using NRT prior to quit day (preloading) may improve quit rates compared to using it from quit day onward, which could be relevant for patients scheduled for surgery 2, 4, 6.
- The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker, and its use can increase quit rates by 50 to 70% regardless of setting 3, 5, 6.
- However, the evidence for the comparative safety and tolerability of different types of NRT use, including nicotine patches, is limited, and new studies should ensure that adverse events, serious adverse events, and withdrawals due to treatment are measured and reported 2, 4.
Key Findings
- High-certainty evidence supports the use of combination NRT (fast-acting form + patch) for long-term smoking cessation 2, 4.
- Moderate-certainty evidence suggests that preloading with NRT may improve quit rates compared to starting NRT on quit day 2, 4, 6.
- NRT can increase quit rates by 50 to 70% regardless of setting, and its effectiveness is largely independent of additional support provided 3, 5, 6.
- The safety and tolerability of NRT, including nicotine patches, require further study to ensure robust findings 2, 4.