A Systematic Approach to Perioperative Smoking Cessation
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2020-01-01
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© 2020 Wolters Kluwer Health, Inc. All rights reserved. Background:There is compelling evidence that smoking leads to poor postoperative outcomes including increased incidence of wound infection, respiratory infection, sepsis, cardiac arrest, and mortality. There is also compelling evidence that smoking cessation before surgery leads to improved outcomes. A recent meta-analysis found that brief smoking interventions may be insufficient to change postoperative outcomes. However, more intensive evidence-based smoking cessation interventions do improve postoperative outcomes and lead to long-term smoking abstinence. From a healthcare perspective, this raises a question of how to best provide effective perioperative smoking cessation treatment to a population.Methods:Duke University Health System recently developed a systematic approach to perioperative smoking cessation. In this report, we outline evidence-based principles for perioperative smoking cessation and describe initial results from a perioperative smoking cessation program.Results:In the first 100 days of the Duke Perioperative Smoking Cessation Program, we received 420 referrals. Participants had a mean pack-year history of 50.3 (packs/day×years smoking; SD 32.5), a mean Fagerström Test for Nicotine Dependence score of 4.5 (SD 2.5), and a mean expired breath carbon monoxide of 11.8 (SD 7.5) parts per million. Mean days from initial perioperative smoking cessation visit to surgery was 21.4 (SD 22.3).Discussion:This model of perioperative smoking cessation is in the early stages of development; however, evidence-based perioperative smoking cessation services can be effective across a health system.
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Davis, JM, LC Thomas, JEH Dirkes and S Aronson (2020). A Systematic Approach to Perioperative Smoking Cessation. Techniques in Orthopaedics, 35(1). pp. 25–30. 10.1097/BTO.0000000000000435 Retrieved from https://hdl.handle.net/10161/21394.
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Scholars@Duke

James Davis
Dr. James Davis is a practicing physician of Internal Medicine, and serves as the Medical Director for Duke Center for Smoking Cessation, Director of the Duke Smoking Cessation Program and Co-Director of the Duke-UNC Tobacco Treatment Specialist Credentialing Program. His research focuses on development of new pharmaceutical treatments for smoking cessation. He is principal investigator on several trials including a study on “adaptive” smoking cessation and several trials on new medications for smoking cessation. The new medications leverage more novel neurobiological mechanisms - NMDA receptor antagonism, nicotinic receptor antagonism, which impact addiction-based learning and cue response. Additionally, Dr. Davis serves as co-investigator on trials on lung cancer screening, e-cigarettes, minor nicotine alkaloids, imaging trials, lung function trials and others. Dr. Davis leads the Duke Smoke-Free Policy Initiative, is co-author on a national tobacco dependence treatment guideline, and provides training in tobacco dependence treatment for the Duke School of Medicine, Duke Internal Medicine, Family Practice and Psychiatry residency programs.

Solomon Aronson
Solomon Aronson, MD, MBA, FACC, FACCP, FAHA, FASE
Solomon Aronson is a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.
Dr. Aronson earned his BS in molecular biology with distinction at the University of Wisconsin in Madison, and his MD with honors in research at the Medical College of Wisconsin in Milwaukee. After completing an anesthesiology residency including a year as chief resident at the University of Texas Medical Branch in Galveston, he completed a fellowship in cardiac and vascular anesthesia at the Texas Heart Institute in Houston. Thereafter was recruited to the University of Chicago where he ascending to the rank of full professor and served as chief of the cardiothoracic and vascular anesthesia division for 12 years. In 2011, Dr. Aronson received his MBA with a concentration in Health Sector Management at Duke University Fuqua School of Business.
Having written over 300 manuscripts, book chapters, abstracts as well as 5 textbooks, he is recognized as an expert on topics concerning perioperative echocardiography, surgical anticoagulation and blood management, perioperative blood pressure risk, healthcare strategy and health economics as well as other related topics in cardiovascular anesthesia and cardiology, he has lectured nationally and internationally.
Among the many research awards and lecture honors received over the years, Dr. Aronson has been repeatedly elected from among his peers to be listed in Best Doctors in America. Dr. Aronson continues to serve on the Joint Commission and AMA task force for overuse as well as the FDA as a consultant SGE after having served on the FDA as a member of the Anesthesia and Life support advisory committee and Anesthetic and Analgesic Drug Products Advisory Committee (AADPAC). He is an elected fellow of the American Heart Association, the American College of Chest Physicians, the American College of Cardiology, and the American Society of Echocardiography and an elective member of the Association of Cardiovascular Anesthesiologist and Association of University Anesthesiologists.
Dr. Aronson is the director of strategic business development for the Physicians Diagnostic Clinic (PDC), a 1600 member physician practice group at Duke and has severed as chair of the Finance Committee for the PDC in the past. He currently serves on the PDC Board of managers. He has served as a member of the economic committee of the American Society of Anesthesiologists for over 10 years and currently serves on the Future Models of Anesthesia Practice committee for the ASA. In addition, he served on the board of directors and was president of the intraoperative council in the American Society of Echocardiography and he also served on the board of directors and was president for the Society of Cardiovascular Anesthesiology. He remains on the board of trustees for the Society of Cardiovascular Anesthesiology and the Society of Cardiovascular Anesthesiology Foundation. He is a founding trustee member of the National Board of Echocardiography and has served on their board of directors. In 2013, he was elected to serve on the Science Accelerator Committee and the Leadership Committee for Cardiopulmonary, Critical Care, Perioperative & Resuscitation Council of the American Heart Association.
Dr. Aronson is married to Dr. Leena Sharma and they have 2 children – twins- in college. In addition to enjoying time with his family, he works at his tennis and golf games, listens to music, pursues drawing and painting interests and enjoys traveling and serving his community. He currently serves on the board of directors for the Boys and Girls Club of America in Durham.
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