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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Date data sharing statement initially provided
Date results information initially provided
Type of registration
Prospectively registered

Titles & IDs
Public title
Can free nicotine replacement therapy (NRT) increase smoking cessation before scheduled surgery?
Scientific title
Can free nicotine replacement therapy (NRT) increase smoking cessation before scheduled surgery?
Secondary ID [1] 288337 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
tobacco use 297314 0
elective surgery 297375 0
Condition category
Condition code
Public Health 297513 297513 0 0
Health service research
Mental Health 297559 297559 0 0

Study type
Description of intervention(s) / exposure
Trial of uptake, acceptability and use of stop-smoking intervention in elective surgical patients who smoke 10+ cigarettes/day. Invitation for a free 5-week supply of nicotine replacement therapy (NRT patches) mailed to participants. Invitation to participate in surgical quit-text program. The 5-week course of NRT will be based on the following regimen: 3-weeks 21mg/24hr patch (Step 1), 1-week 14mg/24hr patch (Step 2) and 1-week 7mg/24hr patch (Step 3). Each patch will be worn for a 24 hour period and replaced by a new patch every 24 hours. The course of patches will be mailed to participants at the time they are placed on the elective surgical wait-list. Monitoring adherence to NRT will be by telephone interview 2 days and 5-weeks after posting the course of patches.
Intervention code [1] 293631 0
Intervention code [2] 293678 0
Treatment: Drugs
Comparator / control treatment
Usual care (consists of a mailed brochure containing information about smoking and surgery and a self-referral form for Quitline call-back service)
Control group

Primary outcome [1] 297071 0
Self-reported quit for 4 or more weeks prior to day of surgery, determined by survey tool/interview. (Survey tool designed specifically for this study), and confirmed by exhaled carbon monoxide testing on day of operation.
Timepoint [1] 297071 0
Survey tool/interview on day of admission for elective surgery, asking about time last smoked.
Primary outcome [2] 297072 0
Self reported quit for >24 hours before surgery, determined by survey tool/interview. (Survey tool designed specifically for this study) plus exhaled carbon monoxide analysis (to confirm non-smoker status)
Timepoint [2] 297072 0
Survey tool/interview on day of admission for elective surgery, asking about time last smoked.
Secondary outcome [1] 319961 0
Proportion of smokers who agree to receive free NRT prior to surgery, determined by review of study records (number of patients accepting NRT program divided by number successfully contacted with offer)
Timepoint [1] 319961 0
Prior to surgery and at termination of study
Secondary outcome [2] 319962 0
Proportion accepting NRT who finish course offered. A telephone call will be made 2-3 days after posting each course of NRT to confirm that the supply was received, to address any participant questions about use and determine if/when use of the supply commenced. An additional call will be made at 5-weeks to determine how much of the course was used e.g. <1 week, <2 weeks etc. There is also a Study phone number for patch queries/problems and self-reports of discontinuance or problems will be recorded.
Timepoint [2] 319962 0
At end of 5-weeks after posting NRT course
Secondary outcome [3] 319963 0
Self-reported 7-day point prevalence abstinence, assessed by phone call to participants after surgery. "Have you smoked at all in the last 7 days (even a puff)?"
Timepoint [3] 319963 0
at 3-months and 6-months after surgery.
Secondary outcome [4] 319964 0
Self-reported smoking reduction (defined by 50% reduction) after surgery, determined by telephone interview. "How many cigarettes per day are you now smoking?"
Timepoint [4] 319964 0
at 3 and 6 months after surgery
Secondary outcome [5] 319965 0
Any quitting while on wait list (successful or relapsing), determined bu survey tool/interview on day of admission for elective surgery. (Survey tool designed specifically for this study).
Timepoint [5] 319965 0
On day of surgery, prior to surgery.
Secondary outcome [6] 319966 0
Use of any stop-smoking medication on wait-list (study stock or other): duration & recency, determined by survey tool/interview on day of admission for elective surgery, asking about stop-smoking medication use in past. (Survey tool designed specifically for this study).
Timepoint [6] 319966 0
Survey tool/interview on day of admission for elective surgery, prior to surgery
Secondary outcome [7] 319967 0
Days subscribed to Quit-text (form quit text monitoring software)
Timepoint [7] 319967 0
duration of study
Secondary outcome [8] 319968 0
Hospital length of stay, from review of hospital records
Timepoint [8] 319968 0
Admission date to discharge date
Secondary outcome [9] 319969 0
Adverse effects of NRT patches e.g skin irritation, nausea/vomiting, headache, These will be assessed from telephone interview on patch initiation and at the 5-week follow-up phone call (when course of NRT ought to have been completed). Additionally, calls to the Study help-line may record patch adverse events.
Timepoint [9] 319969 0
Self-reports throughout the 6-week NRT period to the Study help-line plus the 6-week follow-up call.

Key inclusion criteria
Adults, smoke 10 or more per day, have a phone, on public hospital elective surgery wait-list. Available for data-collection on day of surgery.
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
1. Unable to understand study requirements
2. Age<18
3. Weight <45 kg (from preop HQ)
4.Pregnancy or breastfeeding
5. Contraindication to nicotine patch. eg allergy
6. Already on stop-smoking medication
7. No phone
8. Emergency surgery
9. Not available for data collection on day of surgery.

Study design
Purpose of the study
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation not concealed
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple computer generated randomisation sequence generation
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?

Intervention assignment
Other design features
The wait-list population of smokers (10+ cigarettes/day) will be randomised such that 1 in 4 will not be offered program (control group) and 3 in 4 will receive offer for the program. This is done to ensure the "get offer" population is sufficiently large to determine the uptake and acceptability of free mailed NRT program to smokers having elective surgery.
Phase 4
Type of endpoint(s)
Statistical methods / analysis
This is a pilot program for uptake, acceptability and outcome of a new mailed NRT service for surgical patients. Previous published data at our institution showed the printed quit-pack intervention resulted in the primary outcome (quit >4-weeks before surgery) in 18.8% of smokers. The same intervention will occur in all patients in this study, but adjusting for quitting in non-nicotine dependent patients (i.e less than 10 cigarettes/day), the underlying quit rate (>4-weeks) will be assumed to be 14.3% for smokers of 10 or greater cigarettes per day at Peninsula Health. Lee et al. recently published an effect size for free NRT in their study of 168 smokers of 18% increased abstinence at 30 days and 17% at 1 year. Assuming an effect size of 17% (32.3% of smokers quit for >4-weeks), 92 patients will be required per group (alpha=5%, beta=20%). 150 per group will allow for patients who may be lost to follow-up. Descriptive statistics will be used for baseline demographic data, stopped before/after surgery will be calculated as a proportion (categorical variable) and analysed with Fishers exact test.

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 5060 0
Frankston Hospital - Frankston
Recruitment postcode(s) [1] 12546 0
3199 - Frankston

Funding & Sponsors
Funding source category [1] 292701 0
Name [1] 292701 0
Aust. & NZ College of Anaesthetists
Address [1] 292701 0
Aust. & NZ College of Anaesthetists
Anzca House
630 St Kilda Rd , Melbourne VIC 3004
Country [1] 292701 0
Primary sponsor type
Dr Ashley Webb
Department of Anaesthesia
Frankston Hospital
Hastings Rd, Frankston VIC 3199
Secondary sponsor category [1] 291428 0
Name [1] 291428 0
Address [1] 291428 0
Country [1] 291428 0

Ethics approval
Ethics application status
Ethics committee name [1] 294183 0
Peninsula Health HREC
Ethics committee address [1] 294183 0
C/O Research Office
Frankston Hospital
Hastings Rd Frankston VIC 3199
Ethics committee country [1] 294183 0
Date submitted for ethics approval [1] 294183 0
Approval date [1] 294183 0
Ethics approval number [1] 294183 0

Brief summary
Tobacco remains a major cause of death in Australia & NZ, with 20,000 annual deaths. Approximately 300,000 smokers have elective surgery each year in Australia & NZ. Smoking increases anaesthetic and surgical risks; particularly respiratory complications and wound infections. Stopping smoking for >4 weeks before surgery significantly reduces these risks, but there is little data on the best ways to help patients quit before surgery. Many smokers make unassisted quit attempts prior to surgery but relapse is common so most arrive in hospital having smoked that day.

The use of nicotine patches and engagement with telephone Quitlines significantly increase quitting success in community settings, but have been little studied in surgical populations. Despite strong evidence in their favour, few smokers having surgery use patches and fewer have Quitline contact. There are no studies looking at using these measures at the time patients go onto the surgical wait-list. More research is important because:
(1)Stopping before surgery, especially >4-weeks reduces surgical & anaesthetic complications.
(2)There is often a significant period of time on the surgical waiting list to allow such quit times to be achieved
(3)Surgery is recognised as a teachable moment for behaviour change; a period in one’s life when there is reflection upon health behaviours and increased motivation for positive change.
(4) A significant proportion of patients quitting before surgery remain a lifelong non-smoker. Given the large numbers of smokers having surgery each year, efforts to increase abstinence may be a significant public health benefit.

This is health services research to evaluate if an offer of a stop-smoking program will increase quitting before surgery. Smokers of 10 or more cigarettes per day (nicotine dependent) will be offered a free 5-week course of free nicotine patches shortly after they go onto the waiting list. The 5-week nicotine patch supply will be mailed to patients in order to make their use as easy and convenient as possible; eliminating many of the barriers to use.

Patients who were smokers at time of waiting list placement will be approached on their day of surgery by a data collector and asked for verbal consent for a short interview (<4-minutes). This will ask if they have quit smoking, or made quit attempts before surgery. For those that claim to have quit (>24 hours), we will ask for written permission to confirm this by exhaled carbon monoxide testing plus to make brief telephone contact at 3 and 6 months after surgery to see if they are still quit.

A comparison group of patients who smoke will not have this quit package promoted or offered to them.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 62790 0
Dr Ashley Webb
Address 62790 0
Department of Anaesthesia
Peninsula Health
Frankston Hospital
Hastings Rd,
Frankston VIC 3199
Country 62790 0
Phone 62790 0
Fax 62790 0
Email 62790 0
Contact person for public queries
Name 62791 0
Dr Ashley Webb
Address 62791 0
Department of Anaesthesia
Peninsula Health
Frankston Hospital
Hastings Rd,
Frankston VIC 3199
Country 62791 0
Phone 62791 0
Fax 62791 0
Email 62791 0
Contact person for scientific queries
Name 62792 0
Dr Ashley Webb
Address 62792 0
Department of Anaesthesia
Peninsula Health
Frankston Hospital
Hastings Rd,
Frankston VIC 3199
Country 62792 0
Phone 62792 0
Fax 62792 0
Email 62792 0

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No/undecided IPD sharing reason/comment
What supporting documents are/will be available?
Summary results
Have study results been published in a peer-reviewed journal?
Journal publication details
Publication date and citation/details [1] 5781 0 Anaesthesia, online, October 2019
Other publications
Have study results been made publicly available in another format?
Results – plain English summary
Mailing nicotine patches to smokers >10 day listed for elective surgery stimulated a lot of quitting activity but improvements in quit by surgery or quit for 4-weeks before surgery were only slightly improved, and relapse to smoking following surgery was common. Improving uptake of offers of free mailed NRT, the efficacy of the offer (eg. adding a fast acting NRT drug to the patches for highly dependant smokers) and relapse prevention measures may improve effectiveness