Department of Anesthesia and Nicotine Dependence Center, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clinic College of Medicine and Science, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA.
BMJ. 2017 Sep 6;358:j3340. doi: 10.1136/bmj.j3340.
Treatment for tobacco use is efficacious and beneficial to health. Although guidelines recommend that all patients who use tobacco are offered treatment as a part of their clinical care, implementing treatment has proven challenging. In the case of surgical patients, this lack of treatment is particularly unfortunate, as the benefits of abstinence from tobacco are immediate in terms of reducing the risk of surgical complications, including cardiovascular, respiratory, and wound related complications. Surgery also presents an opportunity for patients to quit for good and reduce the long term health risk. This review examines the principles of tobacco use treatment, the rationale for tobacco use treatment in the perioperative period, and how treatment can be incorporated into the routine care of surgical patients. The discipline of implementation science helps to frame these efforts by seeking to better understand how changes in clinical practice occur, and it has the potential to guide an evidence based approach to embedding tobacco treatment into the routine clinical care of surgical patients. This review uses the consolidated framework for implementation research, which includes five major domains, as a representative conceptual framework. A basic understanding of factors potentially important to successful implementation can help to guide clinicians who accept the challenge of implementing tobacco use treatment in surgical care.
治疗烟草使用是有效的，有益于健康。尽管指南建议所有使用烟草的患者都应接受治疗，作为其临床护理的一部分，但实施治疗已被证明具有挑战性。对于手术患者来说，这种缺乏治疗尤其不幸，因为戒烟可以立即降低手术并发症的风险，包括心血管、呼吸和伤口相关并发症。手术也为患者提供了一个永久戒烟和降低长期健康风险的机会。本文回顾了烟草使用治疗的原则、围手术期进行烟草使用治疗的基本原理，以及如何将治疗纳入手术患者的常规护理。实施科学这一学科通过寻求更好地了解临床实践发生变化的方式来帮助构建这些努力，它有可能为将烟草治疗纳入手术患者常规临床护理提供循证方法。本文使用实施研究的综合框架（包括五个主要领域）作为代表性概念框架。对可能对成功实施有重要意义的因素有一个基本的了解，可以帮助接受在手术护理中实施烟草使用治疗挑战的临床医生。
