Clinical experience of smoking cessation advice in hospital trauma units

Cigarette smoking is increasingly well recognized as an inhibiting factor in fracture healing, and risk factor for non-union. We assessed whether adequate smoking cessation advice and support was given to cigarette smokers undergoing fracture management, based upon the United States Public Health Service 'Five As' Smoking Cessation Guidelines-evidence-based guidelines outlining effective strategy to promote smoking cessation, by taking a smoking history, advising the patient to stop smoking, assessing motivation to stop and facilitating cessation via support groups and pharmacological interventions (Ask, Advise, Assess, Assist, Arrange). Our study was conducted within three large orthopaedic units in the Mersey deanery, UK. A questionnaire was completed by 156 cigarette smokers-inpatients and outpatients-undergoing fracture management (87 M, 69 F, 18-89 years, mean age 48.2 years). All patients included within the study had been seen by an orthopaedic practitioner prior to completing the questionnaire. We assessed whether a member of the orthopaedic team had addressed each patient's smoking habits based upon the 'Five As' approach. A smoking history had been taken from 66% of smokers, 54% of those patients (36% of smokers) were advised to stop smoking. Motivation to stop smoking was assessed in only 4% of patients, whilst assistance and support relating to smoking cessation was offered to only 2.5% of patients. The assessment of smoking prevalence, and subsequent promotion of smoking cessation amongst trauma patients, is clearly suboptimal. We suggest highlighting the significance of smoking as a risk factor for impaired fracture healing amongst all healthcare professionals treating trauma patients, and the incorporation of smoking cessation advice and support into the management of orthopaedic trauma in order to promote improved fracture healing.