Surgery and Smoking

We all know smoking causes cancer, cardiovascular disease, and lung disease. But did you know that smoking also causes complications with surgery?[1] It’s true!

Smoking harms your body’s ability to handle the surgical process and heal afterwards.

The good news is that quitting even a day or two before surgery – and staying quit afterwards – can help your body heal better. Having surgery is a great opportunity to quit. The information and support here on EX can improve your chance of success.

How does smoking affect people having surgery?

  • If you smoke, you have a higher chance of developing complications such as heart attack, stroke, sepsis, shock, and death compared to non-smokers.[2-5]
  • Your surgical wounds are less likely to close, less likely to heal well, and more likely to become infected.[3-9]
  • If you’re having orthopedic (bone or joint) surgery, your bones will take longer to heal than a non-smoker.[10-15] If you’re having plastic surgery, you have a higher chance of scarring. If you’re having breast reconstruction surgery, you have a greater chance of losing your implants than a non-smoker.[16-20]
  • If you’re a parent whose child is having surgery, it is important to stop smoking around their surgery. Children have more complications after surgery if their parents are smokers.[21]

How does stopping smoking affect my surgical outcomes?

If you quit smoking just before surgery, your body can heal better and faster.[22]

One study looked at patients having coronary bypass surgery. Smokers had more than twice as many heart and lung complications than non-smoking patients. On the other hand, patients who had stopped smoking for one month before surgery had no more complications than patients who had never smoked.[23] You can expect fewer complications if you stop smoking 3-4 weeks before other types of surgeries, too.[24]

If you smoke, your body has a harder time healing wounds. Smoking also weakens your immune system. This increases your chances of infection after surgery.[25] The good news is that stopping smoking improves your body’s ability to heal itself immediately.

  • Within a day or two after you quit, your body can bring more oxygen to cells and your blood flow improves. This makes it easier for healing to occur.
  • Three to six weeks after stopping, your body’s defenses against bacterial infection improve. All these changes improve your chances for avoiding complications after surgery.[24-26]

How can I quit smoking if I am scheduled for surgery?

If you are a smoker having surgery in the near future, this is a great opportunity to quit. Many people like you have used their surgery as a good time to quit.[27, 28]

There is no down-side to quitting before surgery.[26, 29-31] Quitting before surgery makes a difference in your body’s ability to heal, even if it is only a day or two before.

There are lots of ways to go about quitting. If you quit using the best science-based methods like those offered here on EX, you are more likely to be able to quit for good.[4, 22, 32-35]

You have the best chance of quitting if you use medications and create a plan to change your smoking behavior.[36] Social support can also improve your chance of success, whether that is family members and friends, or the BecomeAnEX online community.

You can also learn more about quitting around your surgery by watching this video.

  1. Bottorff, J.L., C.L. Seaton, and S. Lamont, Patients' awareness of the surgical risks of smoking: Implications for supporting smoking cessation. Can Fam Physician, 2015. 61(12): p. e562-9.
  2. Corbett, C., M.J. Armstrong, and J. Neuberger, Tobacco smoking and solid organ transplantation. Transplantation, 2012. 94(10): p. 979-87.
  3. Sepehripour, A.H., et al., Is there benefit in smoking cessation prior to cardiac surgery? Interact Cardiovasc Thorac Surg, 2012. 15(4): p. 726-32.
  4. Khullar, D. and J. Maa, The impact of smoking on surgical outcomes. J Am Coll Surg, 2012. 215(3): p. 418-26.
  5. Schmid, M., et al., Impact of smoking on perioperative outcomes after major surgery. Am J Surg, 2015. 210(2): p. 221-229.e6.
  6. Argintar, E., et al., The musculoskeletal effects of perioperative smoking. J Am Acad Orthop Surg, 2012. 20(6): p. 359-63.
  7. Golub, J.S. and R.N. Samy, Preventing or reducing smoking-related complications in otologic and neurotologic surgery. Curr Opin Otolaryngol Head Neck Surg, 2015. 23(5): p. 334-40.
  8. Martindale, R.G. and C.W. Deveney, Preoperative risk reduction: strategies to optimize outcomes. Surg Clin North Am, 2013. 93(5): p. 1041-55.
  9. Santiago-Torres, J., et al., The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review. Am J Sports Med, 2015. 43(3): p. 745-51.
  10. Zhang, W., et al., Risk factors for wound complications of closed calcaneal fractures after surgery: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med, 2015. 23: p. 18.
  11. Arnold, P.M., et al., 162 Tobacco Smoking and Outcomes of Surgical Decompression in Patients With Symptomatic Degenerative Cervical Spondylotic Myelopathy. Neurosurgery, 2016. 63 Suppl 1: p. 165.
  12. Kim, S.J., et al., Effect of Cigarette Smoking on the Clinical Outcomes of ACL Reconstruction. J Bone Joint Surg Am, 2014. 96(12): p. 1007-1013.
  13. Kusin, D.J., U.M. Ahn, and N.U. Ahn, The Effect of Smoking on Spinal Cord Healing Following Surgical Treatment of Cervical Myelopathy. Spine (Phila Pa 1976), 2015. 40(18): p. 1391-6.
  14. Tabaraee, E., et al., Comparison of Surgical Outcomes, Narcotics Utilization, and Costs After an Anterior Cervical Discectomy and Fusion: Stand-alone Cage Versus Anterior Plating. J Spinal Disord Tech, 2015.
  15. Tay, W.H., et al., Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures. Injury, 2014. 45(10): p. 1653-8.
  16. Afshari, A., et al., Preoperative Risk Factors and Complication Rates of Thighplasty: Analysis of 1,493 Patients. Aesthet Surg J, 2016.
  17. Chieng, L.O., et al., Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review. Neurosurg Focus, 2015. 39(4): p. E17.
  18. Coon, D., et al., Plastic surgery and smoking: a prospective analysis of incidence, compliance, and complications. Plast Reconstr Surg, 2013. 131(2): p. 385-91.
  19. Nelson, J.A., et al., Wound healing complications after autologous breast reconstruction: a model to predict risk. J Plast Reconstr Aesthet Surg, 2015. 68(4): p. 531-9.
  20. Voineskos, S.H., S.G. Frank, and P.G. Cordeiro, Breast reconstruction following conservative mastectomies: predictors of complications and outcomes. Gland Surg, 2015. 4(6): p. 484-96.
  21. Shi, Y. and D.O. Warner, Pediatric surgery and parental smoking behavior.Anesthesiology, 2011. 115(1): p. 12-7.
  22. Thomsen, T., N. Villebro, and A.M. Moller, Interventions for preoperative smoking cessation. Cochrane Database Syst Rev, 2014(3): p. Cd002294.
  23. Ji, Q., et al., Impact of smoking on early clinical outcomes in patients undergoing coronary artery bypass grafting surgery. J Cardiothorac Surg, 2015. 10: p. 16.
  24. Pluvy, I., et al., Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations. Ann Chir Plast Esthet, 2015. 60(1): p. e3-e13.
  25. Sorensen, L.T., Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg, 2012. 255(6): p. 1069-79.
  26. Sorensen, L.T., Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg, 2012. 147(4): p. 373-83.
  27. Shi, Y. and D.O. Warner, Surgery as a teachable moment for smoking cessation. Anesthesiology, 2010. 112(1): p. 102-7.
  28. Warner, D.O., Helping surgical patients quit smoking: time to bring it home. Anesth Analg, 2015. 120(3): p. 510-2.
  29. Shi, Y. and D.O. Warner, Brief preoperative smoking abstinence: is there a dilemma? Anesth Analg, 2011. 113(6): p. 1348-51.
  30. Warner, D.O., et al., Cough following initiation of smoking abstinence. Nicotine Tob Res, 2007. 9(11): p. 1207-12.
  31. Warner, D.O. and Y. Shi, Is it dangerous to quit smoking shortly before surgery? Anesthesiology, 2011. 115(5): p. 1137-8; author's reply 1138.
  32. Lee, S.M., et al., Long-term quit rates after a perioperative smoking cessation randomized controlled trial. Anesth Analg, 2015. 120(3): p. 582-7.
  33. Warner, D.O., et al., Telephone quitlines to help surgical patients quit smoking patient and provider attitudes. Am J Prev Med, 2008. 35(6 Suppl): p. S486-93.
  34. Warner, D.O., et al., Quitline Tobacco Interventions in Hospitalized Patients: A Randomized Trial. Am J Prev Med, 2016.
  35. Warner, D.O., et al., Decision Aid for Cigarette Smokers Scheduled for Elective Surgery. Anesthesiology, 2015. 123(1): p. 18-28.
  36. Fiore, M., Treating tobacco use and dependence: 2008 update: Clinical practice guideline. 2008: DIANE Publishing.

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