Letter to the Editor

Editor, – The article on preoperative assessment (Aust Prescr 2014;37:188-91) was a good review, but unfortunately omitted the critical issue of smoking. Smoking causes increased cardiorespiratory complications, intensive care admissions, mortality, wound infections and poorer wound healing after surgery. Smoking cessation before elective surgery can significantly improve postoperative outcomes.1 The perioperative period is a teachable moment when patients are more motivated to quit,2 and some patients who quit may remain abstinent after discharge. However, many opportunities to assist smokers are being missed and most continue to smoke up to the day of surgery.3

The Australian and New Zealand College of Anaesthetists recommends a simple and brief intervention known as the A-A-R strategy.4 It involves:

  • Asking about smoking status
  • Advising smokers to quit
  • Referring them for smoking cessation support.

Smokers can be referred to Quitline (137 848), general practitioners or Tobacco Treatment Specialists (www.aascp.org.au). A brief smoking intervention such as Ask Advise and Refer should be a routine part of preoperative elective surgery care for all anaesthetists and surgeons.

Colin Mendelsohn
Tobacco Treatment Specialist
The Sydney Clinic Consulting Rooms

Colin Mendelsohn has received honoraria for teaching, consulting and travel from Pfizer, GlaxoSmithKline, and Johnson & Johnson. He sits on Pfizer’s Champix Advisory Board.


Author's reply

Austin Ng and Leonard Kritharides, the authors of the article, comment:

We appreciate the important comments made by Dr Mendelsohn. We certainly agree smoking cessation is important for all patients including those undergoing surgery. It should be incorporated into a protocol-driven documentation of the patient’s risk factors during preoperative assessment as recommended by the Australian and New Zealand College of Anaesthetists.


The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Colin Mendelsohn

Tobacco Treatment Specialist, The Sydney Clinic Consulting Rooms, Sydney

Austin Chin Chwan Ng

Cardiologist and Clinical senior lecturer

Leonard Kritharides

Head of Department of Cardiology and Professor in Medicine