Abstaining Smokers Fare Better After Surgery

Authors of a study in this week’s issue of THE LANCET conclude that smokers should avoid smoking for around two months before surgery to reduce the risk of cardiovascular or wound-healing complications.

Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers due to the adverse effects of tobacco smoke on the body’s cardiopulmonary function and immune system. Ann Moller and colleagues from Bispebjerg University Hospital, Copenhagen, Denmark, investigated the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement.

120 patients who were daily smokers were randomly assigned 6–8 weeks before scheduled surgery to either the control or smoking intervention group. Smoking intervention involved counselling and nicotine replacement therapy, and either smoking cessation or at least 50% smoking reduction. The overall complication rate was 18% in the smoking intervention group and 52% in control patients. The most substantial effects of intervention were seen for wound-related complications (5% compared with 31%), cardiovascular complications (0% compared with 10%), and secondary surgery (4% compared with 15%). The average length of hospital stay was reduced in the smoking intervention group compared with controls (11 days compared with 13 days).

Ann Moller comments: “Smoking is a risk factor for wound infection and cardiopulmonary complications in almost any type of surgery; smokers make up a considerable proportion of the total number of postoperative complications. If preoperative smoking intervention can reduce these complications, the savings in personal suffering and financial expense should be substantial. The results of our study should be consolidated by a health-technology assessment, to test applicability and cost benefit when the intervention is implemented in general practice.”

She concludes: “An effective smoking intervention programme applied 6–8 weeks before surgery more than halved the frequency of postoperative complications, with the greatest effect on wound-related and cardiovascular complications. Although the exact duration of smoking abstinence necessary cannot be concluded from these data, we recommend cessation of smoking for at least 6 weeks on the basis of our results.”

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