Preventing Smoking Relapse After Total Joint Replacement Surgery

Hospitalization for elective knee or hip replacement surgery presents an outstanding opportunity to motivate people to quit smoking, because it provides an opportunity to encourage patients to remain smoke-free as they proactively quit to optimize their surgery outcomes. This study will conduct a comparative effectiveness trial of patients who quit smoking pre-operatively, comparing the current standard of care with a novel comprehensive relapse prevention intervention guided by Marlatt's Relapse Prevention Model.

The specific aims of this study are to evaluate the effectiveness and cost-effectiveness of the relapse prevention intervention and will: 1) compare the effectiveness of standard post-operative cessation treatment with a comprehensive relapse prevention intervention on smoking cessation outcomes; 2) conduct a comparative economic analysis to assess the value of the relapse prevention intervention for patients and the healthcare system; and 3) explore the impact of the interventions on surgical complications and readmissions.

Participants randomized to the Intervention Arm will receive counseling that includes: A Visit prior to discharge Follow up calls after discharge Text Messaging Support Caregiver Support

This intervention consists of 4 components: Visit Prior to Discharge: counselor from research team will visit patient at hospital bedside to provide counseling Follow up calls after discharge: 6 proactive counseling calls and initiate unlimited reactive calls to their counselor, at days 1,3,7,14,30,an 60 days after hospital visit Text messaging support: patients will be registered in NCI's Smokefree TXT while in the hospital and will receive multiple daily messages, designed for someone who has already quit Caregiver support: 10 minute training session to the caregiver on how to help patient prevent relapse by increasing self efficacy, maintaining motivation and dealing with high risk situations

Participants will receive two 10 minute counseling calls from the staff of the preoperative counseling program during the first month after the hospital discharge

Inclusion Criteria: Patient Participants Received preoperative smoking cessation counseling through Orthopedic Surgery Quit Smoking Program Undergoing elective knee or hip arthroplasty surgery Have not smoked any cigarettes in the week prior to admission and carbon monoxide 4 ppm46,47 Have a cell phone (for text messaging) Provide informed consent in English Caregiver participants: Age ≥ 18 years Be a caregiver of the patient participant Provide informed consent in English Exclusion Criteria: Patients will be excluded if they used smokeless tobacco or an electronic cigarette in the last 30 days.