E-cigarettes versus nicotine patches for perioperative smoking cessation: a pilot randomized trial

Susan M Lee; Rachel Tenney; Arthur W Wallace; Mehrdad Arjomandi

doi:10.7717/peerj.5609

E-cigarettes versus nicotine patches for perioperative smoking cessation: a pilot randomized trial

PeerJ. 2018 Sep 28:6:e5609. doi: 10.7717/peerj.5609. eCollection 2018.

Authors

Susan M Lee^{1

2

3

4}, Rachel Tenney^{1

2}, Arthur W Wallace^{1

2}, Mehrdad Arjomandi^{5

6}

Affiliations

¹ Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States of America.
² Anesthesia Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America.
³ Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Anesthesia, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
⁵ Medical Section, San Francisco VA Medical Center, San Francisco CA, United States of America.
⁶ Department of Medicine, University of California, San Francisco, CA, United States of America.

Abstract

Introduction: Cigarette smoking by surgical patients is associated with increased complications. E-cigarettes have emerged as a potential smoking cessation tool. We sought to determine the feasibility and acceptability of e-cigarettes, compared to nicotine patch, for perioperative smoking cessation in veterans.

Methods: Preoperative patients were randomized to either the nicotine patch group (n = 10) or the e-cigarette group (n = 20). Both groups were given a free 6-week supply in a tapering dose. All patients received brief counseling, a brochure on perioperative smoking cessation, and referral to the California Smokers' Helpline. The primary outcome was rate of smoking cessation on day of surgery confirmed by exhaled carbon monoxide. Secondary outcomes included smoking habits, pulmonary function, adverse events, and satisfaction with the products on day of surgery and at 8-weeks follow-up.

Results: Biochemically verified smoking cessation on day of surgery was similar in both groups. Change in forced expiratory volume in one second (FEV1) was 592 ml greater in the e-cigarette group (95% CI [153-1,031] ml, p = 0.01) and change in forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC ratio) was 40.1% greater in the e-cigarette group (95% CI [18.2%-78.4%], p = 0.04). Satisfaction with the product was similar in both groups.

Discussion: E-cigarettes are a feasible tool for perioperative smoking cessation in veterans with quit rates comparable to nicotine replacement patch. Spirometry appears to be improved 8-weeks after initiating e-cigarettes compared to nicotine patch, possibly due to worse baseline spirometry and more smoking reduction in the e-cigarette group. An adequately powered study is recommended to determine if these results can be duplicated.

Keywords: Electronic cigarette; Electronic nicotine delivery device; Nicotine replacement therapy; Perioperative; Pilot study; Quit smoking; Randomized controlled trial; Smoking cessation; Tobacco cessation; e-cigarette.

Grants and funding

This work was funded by internal UCSF Department of Anesthesia and Perioperative Care funds (San Francisco, California, United States of America) and the UCSF Resource Allocation Program grant, administered by the Helen Diller Family Comprehensive Cancer Center developmental funds from the National Cancer Institute Cancer Center Support Grant (P30 CA 82103-16). E-cigarettes were purchased from NJOY using these funds. NJOY had no involvement in the design, execution, or analysis of the study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.