Monday, March 21, 2011

Stopping Smoking Before Surgery

 Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

Physicians and surgeons all agree on the link between smoking and postoperative complications.  We don’t agree (or know) how much time is required between cessation of smoking and surgery for optimal risk reduction.
Dr.Thomas Fiala wrote a nice blog post, Smoking Cessation and surgical complications, recently  discussing the 3rd reference article below.
Smokers that quit smoking before surgery had 41% fewer complications. The researchers found that each week of cessation increases the effect by 19%.
Trials of at least 4 weeks' smoking cessation had a significantly larger treatment effect than shorter trials (P = .04).
Smokers that quit had lower rates of total complications, fewer wound healing complications, and fewer pulmonary complications.

The first two articles referenced below were evaluated in an article written by Michael Smith for MedPage Today:  Smokers Who Quit Preop Seem to Do Okay Postop.  Those two articles looked at pulmonary complications not wound healing complications.
There was also no significant benefit or harm when the analysis was restricted to the three studies with biochemical validation of quitting, the researchers reported. The relative risk was 0.57, with a 95% confidence interval from 0.16 to 2.01.
As noted by Clara and Chow (2nd reference, review of 1st reference article) (bold emphasis is mine):
While the review performed by Myers et al provides valuable information, it does not definitively answer the question raise……
Physicians should ideally try to get their patients to stop smoking several months prior to their surgery. The appropriate advice regarding the optimal timing of smoking cessation for patients seen close to their scheduled surgery awaits further research.
I tend to agree with Dr. Fiala who writes, “There is no safe minimum number of cigarettes that you can sneak before surgery. Even a couple can do you in.”

Related posts
Smoking in Facial Aesthetic Surgery Patients (December 28, 2009)

1.  Stopping smoking shortly before surgery and postoperative complications: A systematic review and meta-analysis; Katie Myers; Peter Hajek; Charles Hinds; Hayden McRobbie; Arch Intern Med. 2011;0(2011):archinternmed.2011.97.
2.  The optimal timing of smoking cessation before surgery; Clara K. Chow; P. J. Devereaux; Arch Intern Med. 2011;0(2011):archinternmed.2011.88.
3.  Smoking Cessation Reduces Postoperative Complications: A Systematic Review and Meta-analysis; Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO; The American Journal of Medicine - February 2011 (Vol. 124, Issue 2, Pages 144-154.e8, DOI: 10.1016/j.amjmed.2010.09.013)


Anonymous said...

Eventually, we'll all need to have some kind of surgery. Could be oral. Could be an appendectomy. Could be to replace a joint.
Why don't we all just quit smoking right now and check that one thing off our to do list?
I love getting things done, don't you?


StorytellERdoc said...

Hi Ramona.
I'm with Greg. How about no smoking before surgery, during surgery, or after smoking ever again.

Hope this finds you well.