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Friday, March 17, 2000

Orthopaedists can help patients stop smoking

With no monetary expenditure and just the practitioner's interest, orthopaedic spine surgeons can help patients overcome their nicotine addiction.

A study, presented Thursday in scientific paper 124, found "usual care"-suggesting patients who smoke that they should quit and providing a handout on the effects of smoking on spinal disorder-convinced 19.5 percent of the patients to stop smoking. There was no priority placed on compliance. However, a more aggressive protocol resulted in 36.5 percent of patients who stopped smoking, said Glenn R. Rechtine II, MD, professor, director of spine surgery, department of orthopaedics and rehabilitation, University of Florida College of Medicine, Gainesville.

The more aggressive protocol involved relating the patient's spinal disorder to the smoking status, giving the patient a handout explaining the association of smoking and spinal disorders and telling the patient that they must stop. This was reinforced at each subsequent visit. Elective surgery was not carried out as long as the patient was smoking.

From December 1993 until October 1997, 10,901 new spine patients at the Florida Orthopaedic Institute were surveyed about their current and past nicotine use. Of this group, 1,632 smokers were identified and seen for at least one follow-up visit. Two different physician groups treated the patients with different approaches-usual care or a more aggressive protocol.

"At least 200,000 Americans undergo spine surgery each year," said Dr. Rechtine. "There is an increase in operative complications and poor surgical results in smokers. By decreasing the number of smokers, we should be able to not only decrease the number of surgeries, but also increase the good outcomes from those procedures done.

"The factors that were significant in predicting success in quitting smoking were practitioner effect, older age, shorter smoking history and fewer packs per day. The practitioner effect was the most significant as shown by logistic regression analysis."

The most effective technique a physician can use is to offer repeated advice and support, said Dr. Rechtine. "The simplest way to institute this is to have the receptionist mark the chart so that at each visit, the physician is reminded to discuss the subject of smoking with the patient," he explained. "This should also involve the remainder of the office staff, which will also demonstrate the emphasis that the entire office places on the problem."

Co-authors of the study are Antonio Castellvi, MD, and Ann Gowski, ARNP-C, both of the Florida Orthopaedic Institute; Ann Marie Chrin, ARNP-C, University of South Florida, Tampa; and William Frawley, PhD, University of Texas Southwestern Medical Center, Dallas.

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Last modified 17/March/2000 by IS