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Protocol and Rationale for a Pilot Randomized Controlled Trial: Contingency Management for Veteran Smokers Undergoing Elective Major Surgery
Christy Yim-Fan Wong;
Ellen Herbst;
Elliott Chaney;
Theodore Fetterling;
Isaac A. Mirzadegan;
Phiroz E. Tarapore;
Benjamin Emmert-Aronson;
Gabriela K. Khazanov;
Katherine J. Hoggatt;
Madeline Martinez Rivas;
Sadaf Dabiri;
Jayabhargav Annam;
Julia M. Harris;
Lauren Paver Thompson;
Brian Borsari
ABSTRACT
Background:
Smoking is the leading risk factor for postoperative complications and is associated with longer hospital stays, reoperations, and 30-day mortality. Smoking rates among patients undergoing major elective surgery are high (22.3-43.0%). It is urgent to identify efficacious, strategically timed smoking cessation interventions for patients undergoing surgery.
Objective:
The goal of this pilot randomized controlled trial (RCT) is to design and test feasibility of this first mobile contingency management (mCM) smoking-cessation intervention for military Veterans undergoing major elective surgery and evaluate the effectiveness of mCM while compared to TAU as exploratory analysis.
Methods:
We will adapt and adjust a CM protocol for delivery over 5 weeks using mobile CO monitoring in the perioperative period. We will then test its feasibility and effectiveness in Veteran smokers undergoing major elective surgery (n=36). Participants will be randomized to receive mCM or Treatment-As-Usual (TAU). Both groups will receive pharmacotherapy. Feasibility of mCM will be assessed by 1) recruitment rate, 2) level of engagement, and 3) retention. We will also compare mCM with TAU on smoking cessation outcomes (quit attempts, cigarettes per day, and nicotine dependence severity) over 5 weeks to examine effectiveness.
Results:
The recruitment and data collection started in December 2025. As of March 2026, we enrolled 11 Veterans in this pilot trial.
Conclusions:
Novel interventions to support smoking cessation may reduce morbidity, mortality, and healthcare costs for patients undergoing major surgery. mCM has a high potential to implement widely to improve surgical outcomes. Clinical Trial: ClinicalTrials.gov NCT06678672; https://clinicaltrials.gov/study/NCT06678672
Citation
Please cite as:
Wong CYF, Herbst E, Chaney E, Fetterling T, Mirzadegan IA, Tarapore PE, Emmert-Aronson B, Khazanov GK, Hoggatt KJ, Martinez Rivas M, Dabiri S, Annam J, Harris JM, Paver Thompson L, Borsari B
Contingency Management for Veteran Smokers Undergoing Elective Major Surgery: Protocol and Rationale for a Pilot Randomized Controlled Trial