SLR - September 2013 - Kristin Burton
Reference: Anna Lee, Tony Gin, Po Tong Chui, Perpetua E. Tan, Chun Hung Chiu, Tsui Ping Tam, Winnie Samy. The Accuracy of Urinary Continine Immunoassay
Test Strip as on Add-on Test to Self-Reported Smoking Before Major Elective Surgery. Nicotine Tob Res. 2013: ntt039v1-ntt039.
Scientific Literature ReviewReviewed By: Kristin Burton, DPM
Residency Program: Grant Medical Center, Columbus Ohio
Podiatric Relevance: Up to 35 percent of smokers deny smoking prior to a surgical procedure. In elective podiatric procedures, smoking cessation can be imperative for proper wound healing, especially in patients with other significant co-morbidities. This article proposed obtaining preoperative urinary cotinine levels to assess for compliance of preoperative smoking cessation.
Methods: Self reported smoking history as well as urinary cotinine concentration was obtained from 465 patients undergoing major elective surgery.
Results: Sixty patients had a positive continine concentration (>50 ng/ml). Of these 60 patients with a positive reference standard, 10 (16.7 percent) denied current smoking. The add-on preoperative test had better sensitivity and specificity (95 percent, 94.8 percent) than self-reported sensitivity and specificity (83.3 percent, 95.0 percent). The relative positive and negative likelihood ratios were significantly higher for the add-on test than for the self-reported smoking history alone.
Conclusions: A urine cotinine add-on test has excellent ability to identify smokers preoperatively compared to the patient’s subjective history alone. In elective foot and ankle procedures, this test may be useful to determine if patients are compliant with smoking cessation. This becomes helpful in patients with other significant co-morbidities which may impact healing potential. Smoking is a preventative risk factor that can be controlled in the perioperative setting. The cotinine test can help to determine when elective surgery should be cancelled in high risk patients.