Background: Hospital admission presents an underutilised opportunity to initiate smoking cessation initiatives that can improve disease management and reduce the risk of future hospital utilisation. Yet to date there is no standardised approach to inpatient smoking cessation interventions. Aim: To determine the efficacy, safety and cost effectiveness of smoking cessation initiatives in the hospital setting.Method: Two independent researchers screened and extracted data from randomised controlled trials retrieved from: Medline, EMBASE, PsycINFO, Cochrane Library, trial registries and bibliographies of included studies to identify randomised controlled trials. Meta-analysis was undertaken in RevMan software using standard Cochrane methodology. Results: 63 studies from 2783 citations met the inclusion criteria. At 12 months both point prevalence abstinence (22 studies, OR 1.59; 95%CI 1.44 to 1.75; p<0.00001; I2=43%) and continuous abstinence (15 studies, OR 1.33; 95%CI 1.17 to 1.50; p<0.00001; I2=34%) significantly favored smoking cessation interventions, as did point prevalence (36 studies, OR 1.37; 95%CI 1.27 to 1.49; p<0.00001; I2=51%) and continuous abstinence (16 studies, OR 1.35; 95%CI 1.18 to 1.55; p<0.0001; I2=26%) at less than 12 months. Studies reporting long-term efficacy showed no evidence of any effect for point prevalence abstinence (3 studies, OR 1.24; 95%CI 0.86 to 1.78; I2 63%) or continuous abstinence (one study, OR 1.44; 95%CI 0.77 to 2.70). Conclusion: Available studies found a significant improvement in smoking cessation through inpatient initiated programs that were sustained until but not beyond 12-month follow-up.