Preparing for your Surgery – Stopping Smoking

Introduction

Your Doctor has advised you need surgery (an operation). It is very important that you try to stop smoking at least 4 to 6 weeks before the date of your operation, if possible.

Smoking increases your risk of becoming more unwell and may delay your discharge from hospital.

Smokers:

• Need more anaesthetic during surgery to reduce spasms and coughing because the tar in cigarettes constantly irritates their lungs

• Need more oxygen therapy in the recovery room after an operation because the carbon monoxide from tobacco smoke reduces the oxygen levels in their blood. It can also cause the blood to become more ‘sticky’, which can cause small blood clots around the wound.

• Have a higher risk of developing chest infections after surgery as smoking smothers the cilia (little hairs) that help to clean mucus out of their lungs.

• Have slower wound healing. Less oxygen reaches their wound because nicotine is a stimulant and can cause the arteries to constrict (become narrower), stopping vital oxygen reaching the wound.

• Have a higher risk of developing deep vein thrombosis (DVT) after surgery.

• Have a higher risk of non-union of the bone (difficulty for your bone to heal properly).

Even if you can only manage to give up for a short time before your operation, this will help you to recover more quickly.

How can I get information about stopping smoking?

There is stop smoking support near to where you live, you can get details by ringing the contact numbers at the end of this leaflet. You can also contact your GP or nearest pharmacy (chemist) for advice and support.

What is available to help me stop smoking?

There are various options to help you cope with the withdrawal from nicotine. Nicotine is the drug that encourages you to continue smoking).

These options include:

• ‘Cold Turkey‘ – This means you stop smoking on your chosen day without any product or support

• Nicotine Replacement Therapy (NRT) – There are different types of NRT available, such as skin patches, chewing gum, lozenges, microtabs, inhalators, nasal or oral sprays and NRT oral strips.

The NRT helps you to give up smoking by mimicking (copying) the nicotine your body is used to. It then reduces the nicotine levels slowly, over a 12-week period. NRT can be bought from pharmacies or the supermarket. If this is your choice, you must read and follow the instructions carefully.

NRT can be prescribed by your nearest Stop Smoking Service after an assessment from a trained advisor or by your own GP. The prescription charge for a 12-week course can be much cheaper than smoking.

Unfortunately, you will not be able to use oral NRT products on the day of your operation as you will be nil-by-mouth, but you may still be able to use patches. Ask your anaesthetist for more information.

• Cytisinicline (Cytisine) and Varenicline (Champix) – These medications can be very successful in helping you to stop smoking. They work in a very different way to NRT as the nicotine receptors in your brain become slowly blocked, stopping the withdrawal and pleasure you gain from the nicotine.
  These prescription only medicines may be available from your local Stop Smoking service or GP. They are also prescribed over a 12-week period.

• Electronic cigarettes/Vaping – Vaping refers to the breathing in and out of the vapour produced by an electronic cigarette. The Trust wishes to support those actively trying to give up smoking and agrees vaping is one way of assisting smokers.
  This is consistent with advice from Public Health England who advocate the use of electronic cigarettes as part of a quit attempt, as this is less damaging than smoking cigarettes.
  Vaping is not permitted in any internal building or courtyard within the hospital building. However, it is permitted outside the hospital building, except for the immediate areas close to entrances.

All these products can help you to stop smoking, but motivation, willpower and wanting to change your behaviours and routines are also very important.

Deciding to stop

The first thing you have to do is make up your mind you are going to stop. Set a quit date when you will finally stop. It may be tomorrow or after a weekend, but whenever it is, do not leave it more than 1 week.

Telling friends and family will help you stick to your decision and making sure it is not when you will be attending social functions that could put your quit attempt at risk.

It is often very useful at this point to complete a smoking diary of each cigarette you have and write down how you feel. Are you smoking because of stress, relaxation, social reasons or boredom?

It is also useful to write down positive and negative thoughts about your smoking, for example, you will become fitter, healthier and will save money, as opposed to being unfit and having less money in your pocket. You may also have other more personal reasons to quit.

Preparing to stop

How do I avoid temptation?

Get rid of all your cigarettes, cigars or tobacco. Make it difficult to smoke a cigarette in a moment of crisis. Throw away your ashtrays, matches, lighters and anything else that will remind you about smoking.

Change your habits, for example:

• If you always miss breakfast and smoke a cigarette with a cup of tea or coffee, then it is better to have a different drink such as fresh orange juice or fruit tea. Try to start the day with some breakfast such as cereal or toast to get your metabolism (digestive system) going.

• Try cleaning your teeth as soon as you get up.

• If you always smoke after a meal, do the washing up straight away. This will take your mind off cigarettes. Also, choose a different seat to your normal one, so that your brain does not automatically associate your position with your normal smoking habits.

• Go for a walk.

• Try to avoid social occasions where friends and family might smoke, encouraging you to join them. It is very difficult to say no, particularly if drinking alcohol at the same time.

• Join a gym or exercise class that not only helps you to get fit, but also stops you from becoming bored

• Take up a new hobby that you might not have had the money to do before you stopped.

• Save up for that car or holiday you have always dreamed of. Working out exactly how much you have spent on cigarettes over a year might encourage you to stop.

The day you stop

How should I plan my day?

Try and do things you know will not tempt you to have a cigarette.

Remember from today you are no longer a smoker trying to give up.

Tell yourself you are a non-smoker.

Work through the day without a cigarette and take each day at a time. Plan a treat for the end of the day to reward yourself for not smoking. Have something special to eat or go to the cinema; somewhere you will be less likely to smoke.

‘Staying stopped’

Is it worth the effort?

When the first day is over, you have to make sure you ‘stay stopped’ for good. For some people this is a difficult time, but it will improve your recovery after your operation. If people offer you a cigarette or tobacco, tell them why you have stopped smoking and why it is so important.

How can I relax?

If you smoked to help you relax, you will need to find other ways to relax. Enjoying a new hobby, making time for a long soak in the bath and spending time with non-smoking friends are just some examples to consider.

Will I notice a difference?

As a non-smoker, your food will taste much better and you will really start to enjoy your meals. Quite often putting on weight is a major reason for not trying to stop smoking.

This can be avoided if you eat extra fruit and vegetables in your diet and do not replace your cigarettes with sweet and savoury snacks such as chocolate and crisps.

Can I have the odd cigarette?

The easiest way to ‘stay stopped’ is to never smoke again. The odd cigarette here and there will lead to another and another. If you do start smoking again, treat it as a stumble and start to stop again as soon as possible.

Support available during Inpatient Stay

All hospitals in the North East and North Cumbria are now completely smoke-free, which means no smoking is allowed anywhere on our hospital sites.

Identified smokers and those on a quit journey will be offered Nicotine Replacement Therapy to help manage any cravings or withdrawal symptoms during Inpatient stay.

A member of our Tobacco Dependency Treatment Team will visit and discuss options and support available to you in more detail.

The team will work with you to agree a treatment plan for your stay in hospital. If you want to stop long-term, we can arrange for ongoing support and medication for you when you go home.

I have recovered from my operation and stopped smoking

Congratulate yourself on what you have achieved so far.

Remember, it really is worth ‘staying stopped’. Remind yourself of the benefits to yourself and your family by not smoking.

Contact numbers

Inpatient Tobacco Dependency Treatment Service

Tel: 01642 383813
Email: [email protected]

Stockton – Specialist Stop Smoking Service

Telephone: 01642 383819

Hartlepool – Family Hub

Telephone: 01429 272905

Middlesbrough, Redcar and Cleveland – Specialist Stop Smoking Service

Telephone: 01642 727579

County Durham – Stop Smoking Service

Telephone: 0191 369 2016 or 0800 772 0565

Darlington – Stop Smoking Support

Telephone: 0800 802 1850

National NHS Smokefree Helpline

Telephone: 0300 123 1044

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]