NEW ORLEANS — A smoking cessation intervention boosted quit rates among patients with spinal cord injuries and was associated with improvements in pressure ulcer wound healing.

“Smoking has a negative effect on overall health and secondary complications of spinal cord injury [SCI], including pressure ulcer development and poor wound healing,” said Cheryl A. Lane, NP-C, ANP, FNP, CRRN, CWCN, of the University of Alabama at Birmingham School of Nursing. “It is also associated with decreased life expectancy, pneumonia and sepsis, the two leading causes of death in patients with these injuries.”

By implementing the “5 A” smoking cessation best practice clinical guidelines, Lane and colleagues were able to double the quit rate in the intervention group compared with a control group (41% vs. 21%; P=0.03; N=158), she reported at the American Association of Nurse Practitioner 2015 meeting.

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Prior to initiating the smoking cessation program, smokers presented with a greater number of wounds than nonsmokers — 22% of smokers had four to seven wounds compared with 10% of smokers. Furthermore, it is known that smoking is associated with surgical wound dehiscence and flap surgery failure.

To help patients with spinal cord injuries who smoked quit the habit, Lane and colleagues used the “5 A” smoking cessation guidelines, which consisted of the following steps: 

  • Ask about tobacco use
  • Advise to quit in a strong voice and offer a CD on the secondary complications of SCI associated with smoking
  • Assess patient willingness to quit
  • Assist in quit attempt — offer medication or provide and refer for counseling
  • Arrange for follow-up monthly

After the intervention, the researchers observed an increase rather than a decrease in wound size compared with nonsmokers and those who stopped (P=0.004), the researchers found. Smokers also had the smallest decrease in the number of wounds observed during the study period.

In addition to improvements in quite rates among the intervention group, those who participated had a higher rates of undergoing a desired wound surgery than those who did not (455 vs. 34.8%; P=0.35), a finding that although not statistically significant, was clinically significant.

“Healthcare providers must make every effort to improve the quality of life and life expectancy of SCI individuals by helping them to achieve smoking cessation,” Lane said.

She called for more studies in larger patient populations to confirm the benefits of consistent use of best practice clinical guidelines in helping smokers in the CSI population quite.


  1. Lane CA et al. Poster session. “The Impact of Smoking and Smoking Cessation on Wound Healing in Spinal Cord Inured Patients with Pressure Ulcers.” Presented at: AANP 2015. June 10-14; New Orleans.