Preparing for surgery takes careful thought, planning, support and courage... a perfect time to stop smoking.

Dr Nadine Caron. Academic Surgeon. University Hospital of Northern BC.

Stop Smoking Before Surgery

Studies have shown conclusively that patients who stop smoking before surgery have fewer complications and heal faster than those who continue to smoke.
A number of studies examining the effects of quitting before surgery have been done, and all of them have found that smokers who quit before surgery face better outcomes.
  • Smoking and surgical complications

    2012 systematic review concludes smokers who quit before surgery have fewer complications
    The objective of a large 2012 review was to determine the risks or benefits of short-term (less than four weeks) smoking cessation on postoperative complications. Based on an analysis of 25 studies, it reports that smokers who quit more than four weeks before surgery had lower risk of respiratory and wound-healing complications than current smokers. Quitting less than four weeks before surgery did not appear to increase or decrease postoperative respiratory complications.
     
    Wong J, Lam DP, Abrishami A, Chan M, & Chung F.  Short term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Canadian Journal of Anesthesia 2012; 59: 268-279.
     
  • Smoking and wound healing

    2012 systematic review concludes smoking delays healing in surgical patients

    The objective of a large 2012 systematic review was to clarify how smoking and nicotine affects wound healing processes and to establish if smoking cessation and nicotine replacement therapy reverse the mechanisms involved. In total, 177 articles were included. The author concludes that smoking has a prolonged effect on inflammatory and reparative cell functions leading to delayed healing and complications. Smoking cessation restores the tissue microenvironment rapidly and the inflammatory cellular functions within four weeks. 

    Sorensen LT.  Wound healing and infection in surgery.  The pathophysiological impact of smoking, smoking cessation and nicotine replacement therapy.  Annals of Surgery 2012;  255: 1069-1079.

  • Smoking cessation before surgery

    2012 systematic review demonstrates cessation interventions are effective for surgical patients

    The objective of the review was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Eight random controlled trials were included. The analysis demonstrates both intensive and brief intervention significantly increase smoking cessation at the time of surgery. Interventions that begin four to eight weeks before surgery, include weekly counseling, and use nicotine replacement therapy are more likely to have an impact on long-term smoking cessation.

    Thomsen T, Villebro N, & Møller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2010; Issue 7. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub3. 

  • Smoking and surgical outcomes

    2011 study finds increased mortality among surgical patients who smoke

    The surgical outcomes of current smokers and never smokers were examined in a large US cohort comparison involving a sample of 520,795 non-cardiac surgical patients. The researchers found that smoking was associated with a 40% greater chance of 30-day mortality and a 30-100% greater chance of major morbidity including surgical site infection, pneumonia, unplanned intubation and septic shock.

    Turan A, Mascha EJ, Roberman D, et al. Smoking and perioperative outcomes. Anesthesiology 2011; 114: 837-46. 

  • Surgery as a teachable moment

    2010 study finds surgical patients are willing to quit.

    In a large nationally representative longitudinal study of 5,498 patients conducted in the US, researchers found that undergoing major surgery approximately doubled the chances that a smoker would quit.

    Shi Y, & Warner DO. Surgery as a teachable moment for smoking cessation. Anesthesiology 2010; 112(1):102-7.

  • Fears of quitting immediately before surgery unfounded

    2011 study demonstrates that quitting shortly before surgery is safe
    The 2011 study demonstrates concerns that stopping smoking shortly before surgery (less than eight weeks) may increase postoperative pulmonary complications are unsubstantiated.  Although it may take several weeks to derive pulmonary benefits from quitting, clinicians are advised that “any time is a good time” to encourage pre-surgical patients to quit smoking. 
     
    Shi Y & Warner DO.  Brief preoperative smoking abstinence: Is there a dilemma?  Anesthesia and Analgesia 2011; 113:1348 -1351.