Roughly 1 in 4 surgical patients smokes, higher than state average, study says

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By BRANDON CHEW
Capital News Service 

LANSING — Roughly a quarter of surgical patients in Michigan smoked cigarettes at the time of their operations, according to a study from the University of Michigan.

A study of 328,578 patients having general and vascular surgery from 2012 to 2019 found that 24.1% were active smokers, which is higher than the state average of 18.7% adults.

Michigan’s smoking rate is above the national average of 16%, according to the state Department of Health and Human Services.

“We found that patients with Medicaid and without insurance were over twice as likely to smoke at the time of surgery,” said Dr. Ryan Howard, a U-M surgical resident and the study’s lead author. “That’s not surprising. Other studies have shown that smoking is higher in patients with Medicaid and without insurance.”

Howard said it’s important to reach out to uninsured patients about their tobacco use because they lack adequate medical care. Surgical patients are also more likely to begin to make healthier lifestyle choices, as surgery can provide a “teachable moment,” he said. 

“There’s a lot of research showing that a big life event like undergoing a major surgery, getting a new diagnosis, really motivates patients to change,” Howard said. “All of a sudden, they want to heal as best they can from surgery. 

“If we can use that teachable moment to say ‘Hey, you’ve got to undergo this big operation, now is the time to quit smoking, now’s the time to eat healthy, now’s the time to exercise,’ there’s a lot of research showing that patients are most likely to be successful then,” Howard said.

Of the patients in the study, 60.1% were women and the average age was 54. Researchers collected the data from 70 hospitals. 

Smoking rates among surgical patients varied regionally, ranging from 21.5% in Southeast Michigan to 28% in Northeast Michigan 

Kushal Singh, an analyst for the Michigan Surgical Quality Collaborative in Ann Arbor and coauthor of the study, said researchers could have improved the study by collecting more data on patients’ socioeconomic status, such as household income and education.

Singh said another limitation of the project was the absence of follow-up with patients.

The Surgical Quality Collaborative is working on ways to follow up to ensure patients continue to make healthy lifestyle choices, including limiting or eliminating tobacco use, Singh said. 

Howard said surgery provides an opportunity for doctors to help smokers. 

“The important stuff from the medical field is really engaging patients at the time of surgery, plugging them into resources and establishing follow-up,” Howard said.

“It is great if a patient, two weeks after surgery, they’re all healed up, they’re back to work, they’re eating well,” he said.

“As a holistic medical field, if we can continue to follow up past that, if the patient needs help quitting smoking or even engaging in other other healthy behaviors, that’s a big thing we can do to help.”

The study appeared in the journal JAMA Network Open.