Center for Surgical, Medical Acute Care Research and Transitions, Birmingham VAMC, Birmingham, AL USA.
Transl Behav Med. 2011 Dec;1(4):604-8. doi: 10.1007/s13142-011-0096-1.
Smoking among veterans undergoing surgery is estimated to be 36%. Smoking has been linked to postoperative surgical complications including ischemia and cardiac arrhythmias, pneumonia, deep venous thrombosis, pulmonary embolism, and surgical site infection. Preoperative smoking cessation interventions, in which smokers quit at least 6 weeks prior to surgery, have been shown to be effective both in smoking cessation and reduction of postoperative complications; however, little is known about physician beliefs regarding the optimal location and the responsible provider for intervention, or whether surgery should be postponed or delayed based on smoking status. Within the routine coordination from medical to surgical care, how should cessation interventions best be implemented? To better inform the translation of preoperative best practices for smoking cessation into clinical care in VA, a survey regarding preoperative smoking cessation beliefs and practices was administered to primary care physicians, surgeons, and anesthesia providers. Chi-square tests were used to examine differences in proportions by provider type. Most providers agreed that the primary care clinic is the best location for intervention, with preoperative and surgical clinics ranked by few as the optimal location (13% and 11%, respectively); most respondents (82%) reported that they would refuse or delay surgery in some cases based on smoking status. There were no differences in either beliefs on location or delay based on provider type. Primary care providers were most likely to advise (86.7%) and assess (80.0%) while anesthesia providers were least likely (59.1% and 22.7%, respectively). Taking time to counsel and the belief that dedicated resources would improve quit rates were associated with advising patients to quit smoking, while being uncomfortable with counseling, the belief that acute health takes precedence and the belief that there is not always time to counsel were identified as barriers to assessing patients for smoking cessation intervention. Primary care providers were more optimistic (100%) that patients would quit if counseled, more often (73.3%) reported having time to counsel, and were less likely to report that acute health takes precedence. Most providers believe that smoking cessation would reduce postoperative complications, with the ideal location for the intervention being the primary care clinic, and that some surgical cases should be delayed for this intervention.
接受手术的退伍军人中，估计有 36%吸烟。吸烟与术后手术并发症有关，包括缺血和心律失常、肺炎、深静脉血栓形成、肺栓塞和手术部位感染。术前戒烟干预措施，即吸烟者在手术前至少戒烟 6 周，已被证明在戒烟和减少术后并发症方面都有效；然而，对于医生对于最佳干预地点和责任提供者的信念，以及是否应根据吸烟状况推迟或延迟手术，了解甚少。在常规的医疗到手术护理协调中，应该如何最好地实施戒烟干预措施？为了更好地将术前戒烟最佳实践转化为退伍军人事务部的临床护理，我们向初级保健医生、外科医生和麻醉提供者进行了一项关于术前戒烟信念和实践的调查。卡方检验用于检验不同提供者类型之间的比例差异。大多数提供者认为初级保健诊所是干预的最佳地点，而术前和手术诊所的排名则由少数人认为是最佳地点（分别为 13%和 11%）；大多数受访者（82%）报告说，他们会在某些情况下因吸烟状况而拒绝或推迟手术。无论是对地点的看法还是基于提供者类型的延迟，都没有差异。初级保健提供者最有可能建议（86.7%）和评估（80.0%），而麻醉提供者则最不可能（分别为 59.1%和 22.7%）。花时间进行咨询，并认为专用资源会提高戒烟率与建议患者戒烟有关，而对咨询感到不舒服、认为急性健康优先以及认为没有总是时间进行咨询被认为是评估患者是否进行戒烟干预的障碍。初级保健提供者更乐观（100%），认为如果进行咨询，患者会戒烟，更经常（73.3%）报告有时间进行咨询，并且不太可能报告急性健康优先。大多数提供者认为戒烟可以减少术后并发症，干预的理想地点是初级保健诊所，并且为了进行这种干预，有些手术病例应该延迟。
