Smoking and Surgery

Why Quitting Smoking Can Change Your Surgery Results

Smokers Have Greater Difficulty Getting Off the Ventilator.

Smoking and Surgery

Quitting smoking before surgery and continuing to abstain after surgery is one of the most beneficial changes any surgery patient can make.  Quitting smoking is well known to have many positive impacts on health and is a smart decision no matter the circumstances.  That said, smokers having surgery can dramatically decrease their risk of complications during and after surgery.

Smokers may be accustomed to hearing information about about the health benefits of smoking; however, the health benefits of quitting prior to surgery are immediate and substantial.

Known Surgery Risks For Smokers

A large international study published in 2013 showed the dramatic differences in complications between smoking patients and those who were former smokers.  This study showed that current smokers have a notably higher risk of dying in the 30 days following surgery.  Most commonly, those deaths can be attributed to heart attack, stroke, inability to wean from the ventilator, respiratory failure requiring intubation and ventilator support, and pneumonia.

While the study compared smokers (defined as those had smoked in the year prior to surgery) and past smokers (history of smoking greater than one year in the past), the patient who quits smoking even a day prior to surgery does lower their risk of complications.

In addition to the severe complications known to accompany smoking, there are other complications that can hinder the patient’s ability to recover after surgery.

  Smokers are known to have slower wound healing, greater scarring and higher rates of infection.  Broken bones heal slower and coughing during the recovery phase is more likely, which can increase pain.

When to Quit Smoking Before Surgery

The sooner you can quit smoking prior to surgery, the better.  With each passing smoke-free day your overall risk of complications decreases.

  Quitting even 12 hours prior to surgery can make a difference, but quitting 8 weeks before surgery can have a dramatic impact on your surgery and recovery.  

When you quit matters:

  • 12 hours before surgery: improved oxygenation, blood pressure and heart rate
  • 2 weeks before surgery: less breathing problems during surgery
  • 3 weeks before surgery: wound healing improves
  • 8 weeks before surgery: decreased risk of clot related problems (heart attack and stroke), improved immunity decreases risk of infection, improved response to anesthetic medications

Smoking After Surgery

Continuing to abstain after surgery will improve recovery time and continue to decrease the risk of complications.  By refraining from smoking after surgery, wound healing is improved, the risk of pneumonia is decreased and overall recovery time is minimized.

Long term, the benefits of continuing life as a non-smoker are enormous, decreasing your risk of cancer, severe breathing problems and early death from other causes.

How to Quit Smoking

Giving up cigarettes is not easy, but it is worth the effort, especially before surgery.

  For some patients, “cold turkey” is the answer, quitting cigarettes without medication or nicotine replacement.   For others, nicotine replacements are effective.  Nicotine replacement means that you obtain nicotine from a source other than cigarettes, such as nicotine gum, patches, lozenges and nasal sprays.  

Medication is also an option. There are two medications commonly prescribed to help smokers quit the habit.  The first is Wellbutrin, also known as Zyban or Buproprion, which is medication originally used as an anti-depressant but found to decrease the desire for cigarettes.  The other medication is Chantix, a medication that mimics low doses of nicotine to help reduce withdrawal symptoms.  Chantix also blocks the brain receptors that create a feeling of pleasure when smoking, making the experience of smoking a lackluster one.  

Patients report benefits from therapies that do not include medication or nicotine.  Some have successfully used hypnosis to reduce the urge to smoke, while others relied on acupuncture. 


Quit Smoking. Quit Australia SA. Accessed January 2015.

Smoking and the Risk of Mortality and Vascular and Respiratory Events in Patients Undergoing Major Surgery.  Accessed January, 2015. Musallam et al.

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