A. Patel3, M. Dugan3, A. Wanar3, E. Reinoso Jacome3, M. Ibarra3, C. Rocker1, M. Englesbe1,2 1Michigan Surgical Quality Collaborative (MSQC), Ann Arbor, MI, USA 2University Of Michigan, Section Of Transplant Surgery, Department Of Surgery, Ann Arbor, MI, USA 3University Of Michigan, University Of Michigan Medical School, Ann Arbor, MI, USA
Introduction: Previous studies have suggested that the perioperative period is a “teachable moment” for smoking cessation. As such, the Michigan Surgery Quality Collaborative (MSQC) has integrated a series of targeted QI interventions beginning in 2022 to integrate cigarette smoking cessation into the perioperative setting, including clinical process measures and process and outcome based financial incentives at both the hospital and provider level. To measure the impact of these QI interventions on smoking rates, we report smoking prevalence among surgery patients within the MSQC. Our study aims to demonstrate that a surgical collaborative can be used to affect health behaviors on the population level as well as provide scalable models for broad-based intervention that leverage unique opportunities in patients' lives.
Methods: In this study, we conducted a retrospective analysis of electronic medical record data collected by the MSQC across 69 Michigan hospitals (all hospitals that do major inpatient surgery). A random sample of cases in Michigan yielded the study cohort (N=111,948). The study included adult patients (age greater than 18 years) with complete registry data who underwent elective surgery between January 1, 2022 and July 3, 2024. Patients were excluded if any explanatory variables were incomplete. The primary outcome was cigarette smoking before surgery. Data was collected for a range of surgery types, and we reported outcomes for the three most common surgeries: hernia surgery (23.5%), cholecystectomy (12.4%), and bowel surgery (10.2%), stratified by year.
Results: Overall, smoking rates decreased over the study period from 16.3% in 2022 to 13.9% in 2023 to 13.1% in 2024. For hernia surgery (N = 26,305), smoking rates decreased from 17.5% in 2022 to 14.6% in 2024. For cholecystectomy (N = 13,844), smoking rates decreased from 15.6% in 2022 to 12.8% in 2024. For bowel surgery (N = 11,394), smoking rates decreased from 16.3% in 2022 to 14.4% in 2024.
Conclusion: Over the last three years, perioperative smoking rates for hernia surgery, bowel surgery, and cholecystectomy in MSQC-participating sites have seen a steady decrease. These results suggest that statewide quality collaboratives can be an effective tool in promoting smoking cessation and improving population health across a statewide population.