Stop for the Op and stop for life; Can smoking cessation be increased before elective-surgery by an offer of free mailed nicotine replacement therapy (NRT) and Quitline counselling to smokers waiting for surgery?

INTERVENTION: Randomised controlled trial of uptake, use and smoking cessation outcomes after an offer of smoking cessation help in adult elective surgery patients who smoke, compared to standard care. Intervention group smokers receive an invitation, pre‐surgery, when name is placed on the elective‐surgery wait‐list for free nicotine replacement therapy (NRT) mailed to their home, printed quit information and enrollment in Quitline call‐back service for telephone support. The intended use is for assistance with pre‐surgical quitting. The dose of NRT will vary according to nicotine dependence (a) Highly dependent (smokes >15/day): 5‐weeks of NRT patches, reducing dose regimen as follows: Size, 21‐mg/worn for 24‐hrs, changed daily, duration of use=3 weeks, then size 14‐mg/worn for 24hrs, changed daily, duration of use=1 week then size 7‐mg/worn for 24hrs, changed daily, duration of use=1 week, PLUS 2mg nicotine lozengers, to be used in conjunction with patches if cravings occur, maximum 7 lozengers per day, supply of 72 lozengers. (b) Moderately dependent (10‐15/day): 3‐weeks of patches, size 14‐mg/worn for 24/hrs, changed daily, duration=2 weeks, followed by size 7‐mg/worn for 24hrs, changed daily, duration =1 week, PLUS 2mg nicotine lozengers, to be used in conjunction with patches if cravings occur, maximum 7 lozengers per day, supply of 72 lozengers. (c)Light/intermittent/social (<10/day): No patches, 2mg nicotine lozengers, to be used if cravings occur, maximum 7 lozengers per day, supply of 72 lozengers. Participants in intervention group may request the NRT products at any time prior to their operation date, including an additional course of treatment if the initial products posted did not achieve smoking abstinence prior to surgery. The additional printed information sent to smokers in the intervention group prior to surgery is an existing Quitline resource, https://www.quit.org.au/documents/231/AQ710_Smoking_and_Surgery_DL_update_v5.pdf Participants quit by surgery CONDITION: Mental Health ‐ Addiction Public Health ‐ Health service research tobacco use;cardiovascular risk;elective surgery; ; tobacco use ; cardiovascular risk ; elective surgery PRIMARY OUTCOME: Smoking cessation for >24 hours, confirmed by exhaled carbon monoxide level or 8 parts per million or less , using a calibrated hand held piCO+ Smokerlyzer (Bedfont Scientific, Maidstone, Kent, UK).[Day of surgery] SECONDARY OUTCOME: Contact with Quitline during time on wait‐list, including total number of contacts, determined using a study‐specific questionnaire[By day of surgery] Quit attempts while on wait‐list for surgery (duration of each attempt and time before surgery that quit attempt ended), determined using a study‐specific questionnaire[Days on elective surgery wait‐list] Self‐reported 7‐day point prevalence abstinence, assessed by phone call to participants after surgery. "Have you smoked at all in the last 7 days (even a puff)?" ; [3‐months after surgery] Self‐reported quit at least 4‐weeks before surgery (if >4‐weeks available between wait‐listing and operation), determined using a study‐specific questionnaire.[Day of surgery] INCLUSION CRITERIA: Any smoker Having elective surgery Available for data collection on day of surgery