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Attitudes, Beliefs, and Practices Regarding Electronic Nicotine Delivery Systems in Patients Scheduled for Elective Surgery


      Smokers are at increased risk of postoperative complications. Electronic nicotine delivery systems (ENDS; or electronic cigarettes) could be a useful tool to reduce harm in the perioperative period. This pilot study examined the attitudes, beliefs, and practices of smokers scheduled for elective surgery regarding ENDS. This was a cross-sectional survey of current cigarette smokers who were evaluated in a preoperative clinic before elective surgery at Mayo Clinic. Measures included demographic characteristics, smoking history, 2 indices assessing the perception of how smoking affected health risks, ENDS use history, and 3 indices assessing interest in, perceived benefits of, and barriers to using ENDS in the perioperative period. Of the 112 smokers who completed the survey, 62 (55%) had tried ENDS and 24 (21%) reported current use. The most commonly stated reason for using ENDS was to quit smoking. Approximately 2 in 3 participants would be willing to use ENDS to help them reduce or eliminate perioperative cigarette use, and similar proportions perceived health benefits of doing so. Of the factors studied, only attempted to quit within the last year was significantly associated with increased interest in the perioperative use of ENDS (P=.03). Compared with participants who had tried ENDS (n=62), those who had never tried ENDS (n=50) had a significantly increased interest in the perioperative use of ENDS. A substantial proportion of patients scheduled for elective surgery had tried ENDS and would consider using ENDS to reduce perioperative use of cigarettes.

      Abbreviations and Acronyms:

      ENDS (electronic nicotine delivery system), NRT (nicotine replacement therapy)
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        • Warner D.O.
        Perioperative abstinence from cigarettes: physiological and clinical consequences.
        Anesthesiology. 2006; 104: 356-367
        • Hawn M.T.
        • Houston T.K.
        • Campagna E.J.
        • et al.
        The attributable risk of smoking on surgical complications.
        Ann Surg. 2011; 254: 914-920
        • Woehlck H.J.
        • Connolly L.A.
        • Cinquegrani M.P.
        • Dunning III, M.B.
        • Hoffmann R.G.
        Acute smoking increases ST depression in humans during general anesthesia.
        Anesth Analg. 1999; 89: 856-860
        • Lee S.M.
        • Landry J.
        • Jones P.M.
        • Buhrmann O.
        • Morley-Forster P.
        The effectiveness of a perioperative smoking cessation program: a randomized clinical trial.
        Anesth Analg. 2013; 117: 605-613
        • Wong J.
        • Abrishami A.
        • Yang Y.
        • et al.
        A perioperative smoking cessation intervention with varenicline: a double-blind, randomized, placebo-controlled trial.
        Anesthesiology. 2012; 117: 755-764
        • Shi Y.
        • Ehlers S.
        • Hinds R.
        • Baumgartner A.
        • Warner D.O.
        Monitoring of exhaled carbon monoxide to promote preoperative smoking abstinence.
        Health Psychol. 2013; 32: 714-717
        • Stimson G.V.
        • Thom B.
        • Costall P.
        Disruptive innovations: the rise of the electronic cigarette.
        Int J Drug Policy. 2014; 25: 653-655
        • Franck C.
        • Budlovsky T.
        • Windle S.B.
        • Filion K.B.
        • Eisenberg M.J.
        Electronic cigarettes in North America: history, use, and implications for smoking cessation.
        Circulation. 2014; 129: 1945-1952
        • Cahn Z.
        • Siegel M.
        Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes?.
        J Public Health Policy. 2011; 32: 16-31
        • Polosa R.
        • Caponnetto P.
        • Morjaria J.B.
        • Papale G.
        • Campagna D.
        • Russo C.
        Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study.
        BMC Public Health. 2011; 11: 786
        • Bullen C.
        • McRobbie H.
        • Thornley S.
        • Glover M.
        • Lin R.
        • Laugesen M.
        Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial.
        Tob Control. 2010; 19: 98-103
      1. Berg CJ, Haardoerfer R, Escoffery C, Zheng P, Kegler M. Cigarette users’ interest in using or switching to electronic nicotine delivery systems or smokeless tobacco for harm reduction, cessation, or novelty: a cross-sectional survey of U.S. adults [published online ahead of print June 20, 2014]. Nicotine Tob Res.

        • Zhu S.H.
        • Gamst A.
        • Lee M.
        • Cummins S.
        • Yin L.
        • Zoref L.
        The use and perception of electronic cigarettes and snus among the U.S. population.
        PloS One. 2013; 8: e79332
        • Grana R.
        • Benowitz N.
        • Glantz S.A.
        E-cigarettes: a scientific review.
        Circulation. 2014; 129: 1972-1986
        • Palazzolo D.L.
        Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review.
        Front Public Health. 2013; 1: 56
        • Thomsen T.
        • Tønnesen H.
        • Møller A.M.
        Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation.
        Br J Surg. 2009; 96: 451-461
        • Warner D.O.
        • Patten C.A.
        • Ames S.C.
        • Offord K.P.
        • Schroeder D.R.
        Effect of nicotine replacement therapy on stress and smoking behavior in surgical patients.
        Anesthesiology. 2005; 102: 1138-1146
        • Yu C.
        • Shi Y.
        • Kadimpati S.
        • et al.
        Perioperative smoking behavior of Chinese surgical patients.
        Anesth Analg. 2013; 116: 1238-1246
        • Dawkins L.
        • Turner J.
        • Roberts A.
        • Soar K.
        ‘Vaping’ profiles and preferences: an online survey of electronic cigarette users.
        Addiction. 2013; 108: 1115-1125
        • Warner D.O.
        • Patten C.A.
        • Ames S.C.
        • Offord K.
        • Schroeder D.
        Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery.
        Anesthesiology. 2004; 100: 1125-1137
        • Carroll Chapman S.L.
        • Wu L.T.
        E-cigarette prevalence and correlates of use among adolescents versus adults: a review and comparison.
        J Psychiatr Res. 2014; 54: 43-54
        • Giovenco D.P.
        • Lewis M.J.
        • Delnevo C.D.
        Factors associated with e-cigarette use: a national population survey of current and former smokers.
        Am J Prev Med. 2014; 47: 476-480
        • Harrington K.F.
        • Hull N.C.
        • Akindoju O.
        • et al.
        Electronic cigarette awareness, use history, and expected future use among hospitalized cigarette smokers.
        Nicotine Tob Res. 2014; 16: 1512-1517
        • McBride C.M.
        • Emmons K.M.
        • Lipkus I.M.
        Understanding the potential of teachable moments: the case of smoking cessation.
        Health Educ Res. 2003; 18: 156-170
        • Warner D.O.
        • Klesges R.C.
        • Dale L.C.
        • et al.
        Clinician-delivered intervention to faciliate tobacco quitline use by surgical patients.
        Anesthesiology. 2011; 114: 847-855