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.
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.
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.
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.