Clinical Review State of the Art Review

Perioperative tobacco use treatments: putting them into practice

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3340 (Published 06 September 2017) Cite this as: BMJ 2017;358:j3340
  1. Margaret B Nolan, senior research fellow1,
  2. David O Warner, professor of anesthesiology2
  1. 1Department of Anesthesia and Nicotine Dependence Center, Mayo Clinic, Rochester, MN 55905, USA
  2. 2Mayo Clinic College of Medicine and Science, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA
  1. Correspondence to: D Warner Warner.David{at}mayo.edu

Abstract

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.

Footnotes

  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • We thank Patricia Erwin, MLS, for her assistance with our literature search.

  • Contributors: Both authors contributed to the conceptualization, writing, editing, and design of this manuscript.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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