Smoking Cessation Study

Study Overview
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Brief Summary
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The primary outcome of this study is to determine the true incidence of smokers among patients undergoing joint replacement and secondly, what percent are able to quit smoking before surgery under a structured cessation program with carbon monoxide breath testing. The investigators hypothesize that self-reported smoking status is underreported and that routine carbon monoxide breath testing will improve abstinence rates at the time of surgery.

Detailed Description
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This study looks at patients who have been referred to our clinic for a potential hip and knee joint replacement surgery. Once it has been determined that the patient requires surgical replacement of either their hip or knee and is placed on our surgical waitlist, the patient will be asked if he or she would like to participate in the study. The investigators would ask all patients, both self-declared smokers and non-smokers, to participate. This study would include completing a smoking history questionnaire and a noninvasive carbon monoxide breath test. While smoking status is already assessed in the McGill University Health Centre preoperative questionnaire, the investigators intend on expanding these questions in study participants to better quantify their nicotine exposure.

Official Title
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Carbon Monoxide Breath Testing Prior to Total Joint Arthroplasty to Ascertain Smoking and Aid in Encouraging Smoking Cessation

Conditions
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Arthropathy, Smoking Cessation

Intervention / Treatment
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* Behavioral: Lifestyle Counseling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults ages 18-85 who require a primary total hip or knee replacement Any gender Smokers and non-smokers Osteoarthritis, rheumatoid arthritis, avascular necrosis Exclusion Criteria: Patients who require revision surgery Previous fracture to affected area Emergency surgery Patients who do not understand, read or communicate in either French or English

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Smokers<br>All patients who participate in the study will complete the smoking history questionnaire and the carbon monoxide breath test. All patients with positive carbon monoxide breath test indicative of active nicotine exposure will be provided a structured smoking cessation program that includes information, counseling from their surgeon, or a trained health care professional and referral to a smoking cessation program. | Behavioral: Lifestyle Counseling<br>* Referring to Stop smoking hotline, given pamphlets to encourage quitting smoking, pharmacy guidance, and possible referral to smoking cessation clinic.<br>|
| Non-Smokers<br>Subjects who self-declared as non-smokers | |
| Declared non-smokers with elevated Co2<br>subjects who self-declared as non-smokers but who tested positive for elevated Co2, | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| True incidence of smokers among patients undergoing joint replacement | The percentage of subjects who declare themselves as smokers and non-smokers with elevated Co2 levels. | 15 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To determine the incidence of patients who successfully quit smoking prior to surgery. | The percentage of subjects who were able to quit smoking under a structured cessation program with Carbon monoxide breath testing. | 20 minutes |