Song Fujian, Brown Tracey J, Blyth Annie, Maskrey Vivienne, McNamara Iain, Donell Simon
Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, UK.
Orthopaedic Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
Syst Rev. 2015 Nov 11;4:157. doi: 10.1186/s13643-015-0152-x.
Smoking cessation before surgery reduces postoperative complications, and the benefit is positively associated with the duration of being abstinent before a surgical procedure. A key issue in providing preoperative smoking cessation support is to identify people who smoke as early as possible before elective surgery. This review aims to summarise methods used to identify and recruit smokers awaiting elective surgery.
We searched MEDLINE, EMBASE, CINAHL, and PsycINFO, and references of relevant reviews (up to May 2014) to identify prospective studies that evaluated preoperative smoking cessation programmes. One reviewer extracted and a second reviewer checked data from the included studies. Data extracted from included studies were presented in tables and narratively described.
We included 32 relevant studies, including 18 randomised controlled trials (RCTs) and 14 non-randomised studies (NRS). Smokers were recruited at preoperative clinics (n = 18), from surgery waiting lists (n = 6), or by general practitioners (n = 1), and the recruitment methods were not explicitly described in seven studies. Time points of preoperative recruitment of smokers was unclear in four studies, less than 4 weeks before surgery in 17 studies, and at least 4 weeks before surgery in only 11 studies. The recruitment rate tended to be lower in RCTs (median 58.2 %, range 9.1 to 90.9 %) than that in NRS (median 99.1 %, range 12.3 to 100 %) and lower in preoperative clinic-based RCTs (median 54.4 %, range 9.1 to 82.4 %) than that in waiting list-based RCTs (median 70.1 %, range 36.8 to 85.0 %). Smokers were recruited at least 4 weeks before surgery in four of the six waiting list-based studies and in only three of the 18 preoperative clinic-based studies.
Published studies often inadequately described the methods for recruiting smokers into preoperative smoking cessation programmes. Although smoking cessation at any time is beneficial, many programmes recruited smokers at times very close to scheduled surgery so that the benefit of preoperative smoking cessation may have not been fully effected. Optimal delivery of preoperative smoking cessation remains challenging, and further research is required to develop effective preoperative cessation programmes for smokers awaiting elective operations.
术前戒烟可降低术后并发症，且这种益处与术前戒烟的时长呈正相关。提供术前戒烟支持的一个关键问题是在择期手术前尽早识别吸烟者。本综述旨在总结用于识别和招募等待择期手术吸烟者的方法。
我们检索了MEDLINE、EMBASE、CINAHL和PsycINFO以及相关综述的参考文献（截至2014年5月），以识别评估术前戒烟项目的前瞻性研究。由一位审阅者提取数据，另一位审阅者检查纳入研究的数据。从纳入研究中提取的数据以表格形式呈现并进行叙述性描述。
我们纳入了32项相关研究，包括18项随机对照试验（RCT）和14项非随机研究（NRS）。吸烟者是在术前诊所招募的（n = 18），从手术等候名单中招募的（n = 6），或由全科医生招募的（n = 1），有7项研究未明确描述招募方法。4项研究中吸烟者术前招募的时间点不明确，17项研究在手术前不到4周，只有11项研究在手术前至少4周。RCT的招募率（中位数58.2%，范围9.1%至90.9%）往往低于NRS（中位数99.1%，范围12.3%至100%），基于术前诊所的RCT的招募率（中位数54.4%，范围9.1%至82.4%）低于基于等候名单的RCT（中位数70.1%，范围36.8%至85.0%）。在6项基于等候名单的研究中有4项以及18项基于术前诊所的研究中只有3项是在手术前至少4周招募吸烟者的。
已发表的研究往往对将吸烟者纳入术前戒烟项目的方法描述不足。尽管任何时候戒烟都有益处，但许多项目在非常接近预定手术的时间招募吸烟者，以至于术前戒烟的益处可能尚未完全显现。术前戒烟的最佳实施仍然具有挑战性，需要进一步研究以制定针对等待择期手术吸烟者的有效术前戒烟项目。
