Urinary point-of-care test for smoking in the pre-operative assessment of patients undergoing elective plastic surgery

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Summary

Self-reported information about smoking habit and cigarette consumption can be inaccurate and subject to bias in the clinical setting. Accurate assessment of a given smoking history at point-of-care is valuable. We describe the use of a comprehensive smoking questionnaire and the use of a disposable biomarker test to verify and quantify the exposure to tobacco smoke. This point-of-care test (SmokeScreen®) is a 6-min, easy-to-use urine test that measures nicotine and its breakdown products.

One hundred consecutive patients attending plastic surgery pre-assessment clinic filled in the questionnaire and gave a consented urine sample. Qualitative and semi-quantitative assessment of tobacco consumption was observed by a simple sample colour change set against a standardised colorimetric chart for nicotine metabolite containing urine. The questionnaire self-reported smoking prevalence was 30% with 98% test specificity. The cotinine validated smoking prevalence was 54% with a 26% self-denial rate. Half the patients (n = 15) who admitted smoking on the questionnaire underreported the amount they smoked daily, as quantified by biochemical measurement.

Objective biochemical assessment shows that 26% of self-reporting non-smokers via self-completed questionnaire studies are actual smokers attending this pre-assessment clinic. When patients did report smoking there was consistent underreporting of cigarette consumption.

Section snippets

Methods

A total of 100 patients (62 females, aged 27–78 years, 38 males, aged 18–81 years) attending pre-admission clinic for elective surgery at a large inner-city hospital plastic surgery unit were asked to fill in a comprehensive smoking questionnaire. This was followed by a consented urine sample. All questionnaires were given out and the urine samples were collected by the nursing staff to prevent bias. It has been demonstrated that if the investigator administers the self-report they can identify

Results

Patients attending pre-assessment clinic (n = 100), were recruited to the study, between April and July 2004. No patient refused the urine test post completion of the questionnaire. Eighty-five patients were assessed for general anaesthetics and 15 for local or with a block. The majority were admitted for hand operations (41), 35 for breast and/or abdominal operations and 24 for general plastic surgery procedures.

Discussion

There is growing pressure on smokers to increasingly underestimate consumption, or even to deny smoking altogether. Society has evaluated the true cost of smoking and it is deemed in many countries now to be an anti-social behaviour with bans in public houses, bars and restaurants. In most of the developed world, smoking is the leading preventable cause of morbidity and death despite advances in clinical knowledge and treatment. These facts are true in patients undergoing surgery, but there are

Acknowledgements

We would like to thank Dr Graham Cope, Business Development Manager Surescreen Diagnostics Limited for the supply of the point-of-care urine tests and his invaluable advice in this project.

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    Presented at the British Association of Plastic Surgeons, London, on 5 December 2004.

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