Smokers are at increased risk for surgical complications. Despite the known benefits of smoking cessation, many perioperative health care providers do not routinely provide smoking cessation interventions. The variation in delivery of perioperative smoking cessation interventions may be due to limited high-level evidence for whether smoking cessation interventions used in the general population are effective and feasible in the surgical population, as well as the challenges and barriers to implementation of interventions. Yet smoking is a potentially modifiable risk factor for improving short- and long-term patient outcomes. The purpose of the Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement on Perioperative Smoking Cessation is to present recommendations based on current scientific evidence in surgical patients. These statements address questions regarding the timing and intensity of interventions, roles of perioperative health care providers, and behavioral and pharmacological interventions. Barriers and strategies to overcome challenges surrounding implementation of interventions and future areas of research are identified. These statements are based on the current state of knowledge and its interpretation by a multidisciplinary group of experts at the time of publication.

growing demand for UGRA training [1]. Education may be particularly challenging for those already in established practice because educational opportunities are less obvious. In 2009, the American and European Societies of Regional Anesthesia published guidelines for training pathways in UGRA [2]. For practicing anesthesiologists, they recommended workshops consisting of “didactic teaching and hands-on experience [2].” However, there is limited evidence [3] suggesting that these workshops are effective and can impact participants' clinical practice. We aimed to assess if attendance at a UGRA workshop improved confidence in block performance and impacted clinical practice. Since 2004, the regional anesthesia group at Toronto Western Hospital, University Health Network has conducted semi-annual UGRA workshops. These 2-day workshops consist of didactic lectures, live scanning of models under expert supervision, and needling practice on low fidelity simulators. The course curriculum includes teaching on upper and lower limb blocks, truncal blocks, and neuraxial ultrasound. To assess the impact of the workshop, participants were sent an online survey after completion of two courses in 2018. The primary outcome assessed with our survey was the change in participants' confidence levels post-workshop. Secondary outcomes included participants' perceptions on whether or not the workshop made a relevant impact on their clinical practice and to identify the important factors, which can increase the use of UGRA in clinical practice. Of the 99 people who participated in the two workshops, 58 (59%) responded to the follow-up survey, and 34% of the participants stated that they felt confident in performing UGRA blocks prior to attending the workshop, which increased to 66% after the workshop (P < 0.001; McNemar's test) (Fig. 1A). The major reason participants said they were not confident was the lack of needling practice (67%). Other common reasons included inadequate scanning practice (20%) and insufficient knowledge of block procedure (13%). For less experienced participants (defined as having previously performed less than 50 blocks), there was a significant increase in the percentage of participants who felt confident after the workshop. The number of confident participants in the less experienced group rose from 6% before the workshop to 61% after (P < 0.001; McNemar's test) (Fig. 1B). In contrast, more experienced participants (defined as having previously performed more than 50 blocks) showed no change in their confidence levels before and after the workshop (Fig. 1B). Most (95%) participants stated that the workshop made a relevant impact on their clinReceived: April 28, 2020 Revised: May 4, 2020 Accepted: May 10, 2020

Purpose of Review This review is aimed at discussing the evidence for perioperative smoking cessation interventions and at describing the components of an effective, multimodal smoking cessation intervention. Recent Findings The increased risks associated with smoking around the time of surgery are well established. There is strong evidence for the benefits of perioperative smoking cessation interventions, which include increasing smoking abstinence and decreasing surgical complications. Interventions should aim to start at least 4 weeks preoperatively and provide ongoing support; however, starting any time before or after surgery is beneficial. Collaboration between multiple healthcare providers is important. Accessible patient education tools and appropriate pharmacotherapy are useful adjuvants. Summary Perioperative smoking cessation interventions have proven benefits and should be implemented. This review describes and provides evidence for the various components of a multimodal perioperative smoking cessation program.