Smoking attenuates wound inflammation and proliferation while smoking cessation restores inflammation but not proliferation

Full‐thickness 5 mm punch biopsy wounds were made lateral to the sacrum in 48 smokers and 30 never smokers. After 1 week, the wounds were excised and fixed. The smokers were then randomized to continuous smoking or abstinence with a transdermal nicotine patch or a placebo patch. The sequence of wounding and excision was repeated after 4, 8, and 12 weeks. All excised tissue was stained with hematoxylin–eosin and immunohistochemically for macrophages (CD68), procollagen 1 N‐terminal propeptide (PINP) in fibroblasts, and endothelial cells (CD31). The cellularity was assessed and scored by two independent histopathologists, and for the analysis, proportional odds models and random effect models for repeated measurements were applied. Macrophages and PINP‐stained fibroblasts were reduced in the smokers' wounds (0.28 [0.14–0.58] [OR, 95%CI]; p=0.01 and 0.37[0.19–0.70]; p<0.01, respectively, when compared with never smokers' wounds). Inflammation scores were marginally affected. Following smoking cessation, inflammatory cell infiltration and macrophages in the wounds increased. PINP‐stained fibroblasts were unaffected. Neovascularization was not affected by smoking or abstinence. Wound inflammation and fibroblast proliferation were attenuated in smokers, suggesting delayed healing. Abstinence from smoking restores inflammation, but does not affect proliferation. These findings suggest a pathophysiologic mechanism for postoperative wound infection and dehiscence in smokers and why smoking cessation appears to reduce wound infection but not dehiscence.     

Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes

BACKGROUND: Smoking is associated with surgical wound infections, impaired wound healing, and tissue-destructive disorders. The mechanisms are largely unknown, but changes in the function and activity of inflammatory cells may be involved. METHODS: Seventy healthy volunteers (54 smokers and 16 never smokers) were included. The smokers were studied while they smoked and after 20 days of abstinence. After the first 10 days of abstinence, they were randomized to double-blind treatment with transdermal nicotine patch 25 mg per day or placebo. Venous blood neutrophils and monocytes were sampled and isolated. In 22 randomly selected smokers and in all never smokers, the oxidative burst and chemotaxis were determined by a chemiluminescence response assay and a modified Boyden chamber technique, respectively. Stimulants were opsonized zymosan, formyl-Met-Leu-Phe, and zymosan-activated serum. RESULTS: The neutrophil and monocyte oxidative burst was 50% and 68% lower, respectively, in smokers compared to never smokers (P < .05). Neutrophil chemotaxis was 93% higher in smokers (P < .05). Monocyte chemotaxis was lower in smokers compared to never smokers (P < .05). After 20 days of abstinence, neutrophil oxidative burst increased to the level of never smokers (P < .05); monocyte oxidative burst increased by 50% (P < .05). Chemotaxis was only marginally affected. The changes induced by abstinence were less pronounced in the transdermal nicotine patch group compared to the placebo group. CONCLUSIONS: Smoking attenuates the oxidative burst of inflammatory cells and increases chemotaxis. Three weeks of abstinence normalize the oxidative burst, but affect chemotaxis only marginally.     

Effect of smoking, abstention, and nicotine patch on epidermal healing and collagenase in skin transudate

Delayed wound healing may explain postoperative tissue and wound dehiscence in smokers, but the effects of smoking and smoking cessation on the cellular mechanisms remain unclear. Suction blisters were raised in 48 smokers and 30 never smokers. The fluid was retrieved and the epidermal roof was excised. Transepidermal water loss (TEWL) was measured after 2, 4, and 7 days. Then, the smokers were randomized to continuous smoking or abstinence with a transdermal nicotine patch or a placebo by concealed allocation. The sequence was repeated after 4, 8, and 12 weeks in all smokers and abstainers and in 6 never smokers. Matrix metalloproteinase (MMP)-8 and MMP-1 levels in suction blister fluid were assessed by an enzyme-linked immunosorbent assay. Random-effects models for repeated measurements were applied and p ≤0.05 was considered significant. One week after wounding the TEWL was 17.20 (14.47–19.92) g/cm² hour (mean, 95% CI) in smokers and 13.89 (9.46–18.33) in never smokers ( p <0.01). In abstinent smokers TEWL was 18.95 (15.20–22.70)( p <0.01, when compared with smokers). In smokers, MMP-8 was 36.4 (24.3–48.5) ng/mL (mean, 95% CI) and 15.2 (1.4–30.2) ng/mL in never smokers ( p <0.01). Abstinent smokers' MMP-8 level was 21.2 ng/mL (6.6–43.0) ( p =0.02, when compared with smokers). MMP-1 was unaffected by smoking and abstention. Transdermal nicotine patch did not affect any parameter. We conclude that smoking attenuates epidermal healing and may enhance extracellular matrix degradation. Three months of abstinence from smoking does not restore epidermal healing, whereas 4 weeks of abstinence normalizes suction blister MMP-8 levels. These findings suggest sustained impaired wound healing in smokers and potential reversibility of extracellular matrix degradation.     

Transdermal nicotine patch enhances type I collagen synthesis in abstinent smokers

Cigarette smokers deposit less collagen, expressed as hydroxyproline, in granulation tissue than nonsmokers. We studied the effect of abstinence from smoking and transdermal nicotine patches on deposition of hydroxyproline, proline, type I procollagen, and total proteins. Fifty-four healthy smokers were studied during 10 days of smoking and again from days 10 to 20 following smoking cessation. After the first 10 days of abstinence they were randomized to double-blind treatment with transdermal nicotine patches of 25 mg/day or placebo for a period of 10 days. During this period and during smoking, an expanded polytetrafluoroethylene tube was implanted into the subcutis. Following removal of the implant, total amino acids and peptides were extracted. Hydroxyproline and proline were analyzed by high-pressure liquid chromatography, type I procollagen was analyzed by enzyme-linked immunoassay, and total proteins were determined colorimetrically. In the 39 subjects who complied with the study protocol, abstinence from smoking did not affect the deposition of hydroxyproline, proline, type I procollagen, or total protein in the implants. During abstinence, the type I procollagen level increased by 18% in the transdermal nicotine patches group and decreased by 10% in the placebo group (p<0.05). We conclude that 20 days of abstinence from smoking does not affect collagen deposition in granulation tissue. However, in abstinent smokers, transdermal nicotine patches appears to increase type I collagen synthesis.     

Effect of nicotine replacement therapy on stress and smoking behavior in surgical patients

BACKGROUND: Many surgical patients are dependent on nicotine. Smoke-free policies in healthcare facilities mandate abstinence from smoking, which could contribute to psychological stress in the perioperative period. The authors tested the hypothesis that nicotine replacement therapy decreases psychological stress in cigarette smokers scheduled to undergo elective surgery and determined whether nicotine replacement therapy affects postoperative smoking behavior, even when not specifically prescribed to promote abstinence. METHODS: In this double-blind, placebo-controlled trial, 121 smokers, of whom 116 received a study intervention, were randomly assigned to receive either active (nicotine-containing) or placebo patches, beginning on the morning of surgery and continuing for up to 30 days after discharge from the hospital. Outcomes included the Perceived Stress Score, the Nicotine Withdrawal Score, and subject self-report of smoking behavior. RESULTS: The Perceived Stress Score and the Nicotine Withdrawal Score did not change significantly from baseline over the immediate perioperative period and did not differ between active or placebo patch groups (all P > 0.19). The percentage of placebo versus active patch subjects reporting 7-day abstinence at 30 days postoperatively (30% vs. 39%; P = 0.29) did not differ significantly between groups. At 30 days postoperatively, subjects in both groups significantly reduced their cigarettes smoked per day from baseline, but those receiving active patches reported a greater decrease (a mean decrease of 11 +/- 11 vs. 15 +/- 7 cigarettes/day in placebo and active groups; P = 0.045). CONCLUSION: Routine nicotine replacement therapy is not indicated in smokers undergoing surgery for the purposes of managing nicotine withdrawal and stress but can modify some aspects of postoperative smoking behavior.     

Effect of Nicotine Replacement Therapy on Stress and Smoking Behavior in Surgical Patients

Background: Many surgical patients are dependent on nicotine. Smoke-free policies in healthcare facilities mandate abstinence from smoking, which could contribute to psychological stress in the perioperative period. The authors tested the hypothesis that nicotine replacement therapy decreases psychological stress in cigarette smokers scheduled to undergo elective surgery and determined whether nicotine replacement therapy affects postoperative smoking behavior, even when not specifically prescribed to promote abstinence.

Methods: In this double-blind, placebo-controlled trial, 121 smokers, of whom 116 received a study intervention, were randomly assigned to receive either active (nicotine-containing) or placebo patches, beginning on the morning of surgery and continuing for up to 30 days after discharge from the hospital. Outcomes included the Perceived Stress Score, the Nicotine Withdrawal Score, and subject self-report of smoking behavior.

Results: The Perceived Stress Score and the Nicotine Withdrawal Score did not change significantly from baseline over the immediate perioperative period and did not differ between active or placebo patch groups (all P > 0.19). The percentage of placebo versus active patch subjects reporting 7-day abstinence at 30 days postoperatively (30% vs. 39%; P = 0.29) did not differ significantly between groups. At 30 days postoperatively, subjects in both groups significantly reduced their cigarettes smoked per day from baseline, but those receiving active patches reported a greater decrease (a mean decrease of 11 +/- 11 vs. 15 +/- 7 cigarettes/day in placebo and active groups; P = 0.045).     

Smokers, Risks, and Complications in Abdominal Dermolipectomy

Cigarette smoke has many detrimental effects on health, with consequences such as cardiovascular diseases, respiratory diseases, and tumors. In plastic surgery, these effects appear during the wound healing process. This retrospective study showed wound healing in 57 patients who had undergone abdominal dermolipectomy surgery. The patients were divided into two groups: smokers and nonsmokers. According to the results, smokers face a great complication risk for surgical wounds, which cause aesthetically more undesirable scars than observed in nonsmokers. The authors hypothesize that abstinence from smoking for 4 to 12 weeks before surgery would improve the quality of the scars.     

The effect of vascular endothelial growth factor on the healing of ischaemic skin wounds.

The effect of exogenous vascular endothelium growth factor (VEGF) on wound healing in an ischaemic skin flap model was evaluated in this study. Seventy-two Sprague-Dawley rats were used. Normal incisional wound and H-shaped double flaps were used as the wound models. The study was divided into two parts. In Part I, VEGF protein levels were determined from the incisional and H-shaped ischaemic wounds at 12 and 24 h, postoperatively. In Part II, tensile strength and immunohistochemical stains were examined to determine the level of microvessel density (MVD) at 1 and 2 weeks, postoperatively in simple incisional wounds, ischaemic wounds, and ischaemic wounds following 1 ml (1 microg/ml) exogenous VEGF injections into the subcutaneous tissue. The results showed a significantly higher level of VEGF protein in the ischaemic wounds than the incisional wounds. Tensile strength was statistically higher in the incisional wound group and in the ischaemic flap wounds with VEGF treatment compared to the ischaemic flaps with no treatment at 1 week, postoperatively (p>0.05). MVD data indicated that ischaemic wound repair with VEGF treatment had significantly higher MVD than the normal incisional wounds and ischaemic wounds without treatment. We conclude that exogenous application of VEGF can increase early angiogenesis and tensile strength in the ischaemic wound.     

猪切口疝模型的建立及使用生物型补片修补的研究

目的 建立小猪切口疝模型并探讨生物型疝补片在切口疝修补治疗中应用的可行性.方法 通过在小猪上腹部制作一个肌肉筋膜层缺损区的方法 建立切口疝模型,分别采用二期修补和一期修补的方式,使用生物型补片无张力修补切口疝.观察术后切口感染、疝复发等并发症及补片组织的病理学变化.结果 术后1周时可获得典型的切口疝模型;一期修补组未发生切口疝,二期修补组6只小猪成功,2只因切口感染、补片排出而失败.术后6个月内观察,生物补片的胶原变性吸收,逐渐被结缔组织所替代,大体上逐渐形成一致密结缔组织层并自体腱膜化.结论 本研究所采用的切口疝模型制作方法 成功率高、可重复性好.用生物型疝补片修补小猪切口疝可行,并预示着此生物补片可能是一种较为理想的腹外疝修补材料.     

Does the nicotine patch help in the postoperative period for arterial vessel repair?

This study attempts to determine whether a nicotine patch will affect the patency rate of the femoral artery anastomosis in a smoking rat model. Twenty-four rats underwent a smoking protocol of 4 weeks of exposure to cigarette smoke in a smoking chamber at 1 hour per day, using a 1:10 dilution of unfiltered cigarette smoke. Each rat then underwent a femoral artery transaction and anastomosis. Postoperatively, the rats were divided into two groups of 12. Group I had no postoperative smoking or nicotine therapy. Group II had nicotine patch treatment only. The femoral artery was evaluated for flow 7-days postoperatively. At the time of anastomosis, the femoral arteries were smaller in diameter, averaging 0.5 mm (0.4-0.7 mm) as opposed to the normal 0.75-1 mm. All anastomoses were patent at 5 min when the wound was closed. No difference in patency rate occurred with the use of the nicotine patch.     

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??Therapeutic effect of open incisional hernia mesh repair: A report of 636 cases HU Xing-chen??LI Shao-jie??TANG Jian-xiong, et al. Center of Treatment and Training for Hernia and Abdominal Wall Surgery??Huadong Hospital Affiliated to Fudan University??Shanghai 200040??China
Corresponding author??TANG Jian-xiong??E-mail??johnxiong@china.com
Abstract Objective To analyze the clinical efficacy of open incisional hernia mesh repair. Methods The clinical data of 636 cases of open incisional hernia mesh repair performed from December 2002 to September 2013 in Huadong Hospital Affiliated to Fudan University were analyzed retrospectively. According to the different types of incisional hernia??different patch and different surgical method were used. Recurrence??wound infection??chronic pain??patch infections??intestinal fistula, seroma and other complications were observed and analyzed. Results There were 5 cases of death (0.8%) after operation. There were 26 cases (4.1%) of recurrence??41 cases (6.4%) of wound infection or fat liquefaction??5 cases (0.8%) of chronic pain??10 cases (1.6%) of patch infection??12 cases (1.9%) of intestinal fistula and 6 cases (0.9%) of seroma. Recurrence rate of IPOM was lower than that of Sublay. Compared with Proceed??GORE-TEX DualMesh Composix or Kugel patch had high incidence of wound infection (P<0.01)??while using Composix E / X Mesh patch had no difference in incidence of wound infection (P>0.05). Incidence of patch infection of GORE-TEX DualMesh was significantly higher than that of Proceed (P<0.01). Conclusion Open incisional hernia mesh repair is a safe and effective technique. It would like to use different operations for different patients.     

Effect of nicotine, silver acetate, and ordinary chewing gum in combination with group counselling on smoking cessation.

Four hundred and ninety six smokers participated in a randomised comparison of the effect of silver acetate, nicotine, and ordinary chewing gum on smoking cessation. All were motivated to stop smoking abruptly and all had smoked at least 10 cigarettes a day for at least five years. Side effects and taste acceptability were related to outcome after six months. The participants attended nine meetings over a year, at which lectures, support, and advice about stopping smoking were given. Tobacco abstinence was confirmed by measurement of carbon monoxide in expired air. The chewing gums were used for 12 weeks. After 12 weeks there was a trend towards more abstainers in the nicotine group (59%) than in the silver acetate (50%) and ordinary (45%) chewing gum groups that was not quite significant (p = 0.07). At 26 and 52 weeks the number of cigarette abstainers was similar in the three treatment groups. Subjects in the nicotine chewing gum group had a longer mean time before relapse than those in the silver acetate and ordinary chewing gum groups. Mean success rates for all subjects combined at 12, 26, and 52 weeks were 52.8%, 39.7%, and 23.3%. The side effects of nicotine and silver acetate chewing gum were generally mild and transient, and unimportant except for mouth irritation from silver acetate, which had a negative effect on outcome, and the low taste acceptability of nicotine, which had a strong negative influence on the success rate. The results suggest a short term effect on nicotine chewing gum on smoking cessation, but the abstinence rates after one year were generally disappointing.     

Clinical trial comparing nicotine replacement therapy (NRT) plus brief counselling,brief counselling alone,and minimal intervention on smoking cessation in hospital inpatients

BACKGROUND: Guidelines recommend that smoking cessation interventions are offered in all clinical settings to all smokers willing to make a quit attempt. Since the effectiveness of routine provision of behavioural counselling and nicotine replacement therapy (NRT) to smokers admitted to hospital has not been established, a randomised controlled trial of these interventions given together compared with counselling alone or minimal intervention was performed in hospital inpatients. METHODS: Medical and surgical inpatients who were current smokers at the time of admission were randomised to receive either usual care (no additional advice at admission), counselling alone (20 minute intervention with written materials), or NRT plus counselling (counselling intervention with a 6 week course of NRT). Continuous and point prevalence abstinence from smoking (validated by exhaled carbon monoxide <10 ppm) was measured at discharge from hospital and at 3 and 12 months, and self-reported reduction in cigarette consumption in smokers was assessed at 3 and 12 months. RESULTS: 274 inpatient smokers were enrolled. Abstinence was higher in the NRT plus counselling group (n=91) than in the counselling alone (n=91) or usual care (n=92) groups. The difference between the groups was significant for validated point prevalence abstinence at discharge (55%, 43%, 37% respectively, p=0.045) and at 12 months (17%, 6%, 8%, p=0.03). The respective differences in continuous validated abstinence at 12 months were 11%, 4%, 8% (p=0.25). There was no significant difference between counselling alone and usual care, or in reduction in cigarette consumption between the treatment groups. CONCLUSIONS: NRT given with brief counselling to hospital inpatients is an effective routine smoking cessation intervention.     

Smoking and wound healing problems in reduction mammaplasty: is the introduction of urine nicotine testing justified?

We sought to prove a significant relationship between cigarette smoking and wound healing problems in reduction mammaplasty patients, to show the effect of stopping smoking before the procedure, and to justify the implementation of urine nicotine testing preoperatively. One hundred and seventy-three consecutive patients aged 16 to 67 years underwent bilateral reduction mammaplasty in our institution over 26 months. Patients were advised to stop smoking at least 4 weeks prior to surgery. Records were reviewed and smoking habits reconfirmed via telephone. Wound problems were registered when intervention was necessary. Smokers made up 38.5% of the cases. Wound healing problems showed statistical significance (P < 0.05) between smokers (55.4%) and nonsmokers (33.7%). More than 75% of smokers admitted denying smoking within 4 weeks of surgery. Trend analysis revealed a significant association of wound healing problems for those who stopped longer than 4 weeks (33.3%), those who stopped less than 4 weeks (52.6%), and those who persisted until the operation (67.7%). Smoking increased wound healing problems after bilateral reduction mammaplasty. The introduction of compulsory urine nicotine testing at the preadmission clinic and prior to the operation will provide objective verification of patients' smoking history, minimize morbidity, and enable healthcare cost savings.     

Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery

BACKGROUND: The forced abstinence from cigarettes accompanying surgery in smoke-free facilities may increase psychological stress by removing a coping mechanism and by nicotine withdrawal. The authors tested the hypothesis that abstinence from cigarette smoking contributes to psychological stress in the perioperative period. METHODS: The authors assessed measures of nicotine withdrawal (Hughes-Hatsukami nicotine withdrawal scale) and perceived stress (including the Perceived Stress Scale) in 141 cigarette smokers scheduled to undergo elective surgery. To separate the effects of stress arising from tobacco abstinence from the effects of other perioperative stressors, such as pain, these measures were also obtained in 150 surgical patients who did not use tobacco. Assessments were performed at intervals beginning at the time of preoperative medical evaluation and ending 30 days postoperatively. RESULTS: Perceived Stress Scale scores were significantly (P < 0.001) higher in smokers throughout the study period. There was little significant interaction between smoking status and time, indicating that changes in Perceived Stress Scale score during the perioperative period did not differ between smokers and nonsmokers. The same result was found if analysis was restricted to data collected before hospital discharge (and thus during assured abstinence). Similar results were found for the nicotine withdrawal scale, suggesting that smokers did not experience more withdrawal symptoms relative to nonsmokers. CONCLUSIONS: Although smokers report increased baseline stress, smoking status does not affect changes in perceived stress over the perioperative period. Nicotine withdrawal symptoms do not seem to be a clinically significant problem in the perioperative period for most smokers.     

Prospective study on the effect of smoking and nicotine substitution on leucocyte blood counts and relation between blood leucocytes and lung function

BACKGROUND: The influence of smoking and of nicotine substitution on the counts of total blood leucocytes and leucocyte subsets and the relations between the counts and lung function was investigated. METHODS: The study was a combined cross sectional and prospective study of 298 smokers and 136 non-smokers. Forced expiratory volume in one second (FEV1) was measured in all participants at baseline and six months after quitting smoking in 160 ex-smokers (quitters) and 138 persons with smoking relapse. Blood samples were obtained from all participants at baseline and from 160 quitters and 30 continuing smokers two, six, 12, and 26 weeks after smoking cessation and from 92 quitters one year after the cessation of smoking. RESULTS: Blood leucocyte counts and leucocyte subsets were all higher in smokers than in non-smokers. In cigarette smokers total leucocyte, neutrophil, and lymphocyte blood counts showed a dose dependent relationship with the daily cigarette consumption and pack years consumption. In smokers the neutrophil blood count was independently associated negatively with FEV1 residuals. After quitting smoking total leucocyte, neutrophil, and lymphocyte blood counts decreased during the first 26 weeks and after one year lymphocyte blood counts were higher than in non-smokers. In quitters substituted with nicotine chewing gum (2 mg) the accumulated number of pieces of chewing gum used in the 12 weeks had an inverse relationship with the decrease in the total lymphocyte blood count at 12 weeks after smoking cessation. CONCLUSIONS: Leucocyte blood counts are raised in smokers and decrease after smoking cessation. Neutrophil blood counts had an inverse relationship with lung function and nicotine may increase lymphocyte blood counts in smokers.     

Smoking cessation interventions in clinical practice.

OBJECTIVES: Physicians are in a unique position to advise smokers to quit by integrating the various aspects of nicotine dependence. This review provides an overview of interventions for smokers presenting in a clinical setting. RESULTS: Strategies used for smoking cessation counselling differ according to patient's readiness to quit. For smokers who do not intend to quit smoking, physicians should inform and sensitise them about tobacco use and cessation. For smokers who are dissonant, physicians should use motivational strategies, such as discussing barriers to cessation and their solutions. For smokers ready to quit, the physician should show strong support, help set a quit date, prescribe pharmaceutical therapies for nicotine dependence, such as nicotine replacement therapy (i.e., gum, transdermal patch, nasal spray, mouth inhaler, lozenges, micro and sublingual tablets) and/or bupropion (atypical antidepressant thought to work by blocking neural reuptake of dopamine and/or nor epinephrine), with instructions for use, and suggest behavioural strategies to prevent relapse. The efficacy of all of these pharmacotherapies is comparable, roughly doubling cessation rates over control conditions. Varenicline is a promising new effective drug recently approved by many health authorities. CONCLUSION: Physician counselling and pharmacotherapeutic interventions for smoking cessation are among the most cost-effective clinical interventions.     

Risk reduction: perioperative smoking intervention

Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation, and offered a smoking intervention programme whenever possible.     

Smoking Behavior and Perceived Stress in Cigarette Smokers Undergoing Elective Surgery

Background: The forced abstinence from cigarettes accompanying surgery in smoke-free facilities may increase psychological stress by removing a coping mechanism and by nicotine withdrawal. The authors tested the hypothesis that abstinence from cigarette smoking contributes to psychological stress in the perioperative period.

Methods: The authors assessed measures of nicotine withdrawal (Hughes-Hatsukami nicotine withdrawal scale) and perceived stress (including the Perceived Stress Scale) in 141 cigarette smokers scheduled to undergo elective surgery. To separate the effects of stress arising from tobacco abstinence from the effects of other perioperative stressors, such as pain, these measures were also obtained in 150 surgical patients who did not use tobacco. Assessments were performed at intervals beginning at the time of preoperative medical evaluation and ending 30 days postoperatively.

Results: Perceived Stress Scale scores were significantly (P < 0.001) higher in smokers throughout the study period. There was little significant interaction between smoking status and time, indicating that changes in Perceived Stress Scale score during the perioperative period did not differ between smokers and nonsmokers. The same result was found if analysis was restricted to data collected before hospital discharge (and thus during assured abstinence). Similar results were found for the nicotine withdrawal scale, suggesting that smokers did not experience more withdrawal symptoms relative to nonsmokers.     

Efficacy of bupropion in the indigenous Maori population in New Zealand

BACKGROUND: Smoking rates are high in indigenous populations and contribute to their poor health. In New Zealand the indigenous Maori population has a high rate of smoking, with around 50% of adults being smokers compared with 20% of the adult European population. A study was undertaken to determine whether bupropion is effective in the treatment of smoking cessation in the indigenous Maori population in New Zealand. METHODS: A randomised, placebo controlled, double blind, parallel group study was performed in 134 Maori smokers aged 16-70 years who smoked more than 10 cigarettes per day. The main outcome measures were continued abstinence from smoking at 3 and 12 months. RESULTS: At each time point continued abstinence was better for the subjects allocated to bupropion, with a risk ratio for abstinence over all time points of 2.44 (95% CI 1.22 to 4.88). The rates of continued abstinence in the bupropion and placebo groups at 3 months were 44.3% and 17.4%, respectively, with a risk ratio of 2.54 (95% CI 1.30 to 5.00). The corresponding figures at 12 months were 21.6% and 10.9%, respectively, with a risk ratio of 1.99 (95% CI 0.79 to 5.00). CONCLUSION: Bupropion is an effective treatment for smoking cessation in the indigenous Maori population in New Zealand.