Smoking and surgery don’t mix

Why quit smoking? I wondered what I’d get if I googled this question and was interested in the very different approaches of the two websites I landed on first, the NHS site Smokefree and one from the US, WhyQuit. Smokefree’s approach is measured, with much emphasis on the benefits of giving up smoking and access to a range of support tools. WhyQuit, which encourages smokers to stop abruptly, focuses on the consequences of not quitting, with stories and often shocking photos of individuals who have suffered greatly and died prematurely through their addiction to nicotine.

There are, of course, many approaches to convincing people that they should give up smoking and lots of reasons why this is a good idea. One reason that might be offered to a smoker awaiting planned surgery is that not smoking is likely to reduce the risk of wound healing complications. Authors of a systematic review on smoking and healing problems after surgery, recently published in the Archives of Surgery, note that up until now this evidence has been lacking and that the impact of smoking on healing complication rates was unclear. The review also looked for evidence on the impact of interventions to help people to stop smoking before and after surgery. Almost 480,000 smokers and non smokers from 140 cohort studies across many countries and surgical specialities were compared and four randomised controlled trials (RCTs) of smoking cessation interventions, conducted with 416 patients in Denmark and Sweden, were evaluated. Self-reported smoking or abstinence in the RCTs was validated by biochemical tests. Here’s what they found:

  • Postoperative healing complications occured significantly more often in smokers compared with nonsmokers and in former smokers compared with those who never smoked
  • Smoking cessation intervention from at least four weeks before surgery reduced surgical site infections, but not other healing complications
  • Many of the cohort studies had problems in their design, conduct or reporting, which weakens the strength of the evidence
  • The RCTs were judged to be of low risk of bias, but the authors note that the sample sizes in two may have been too small to show a significant difference in healing complications

This was a well-conducted systematic review but, as so often, it has shown a need for more high quality research. It’s also important to note that even the best cohort studies can only show a link between factors, not that one thing caused another, so these studies simply show that more smokers had healing complications.

Meanwhile, the World Health Organisation has some clear messages about quitting smoking. Smokers are ready to quit once they believe it is important to them and that they have a good chance of succeeding. Tobacco use is dangerous (and their poster of the smoker’s body illustrates why) but many evidence-based supports are available to help smokers increase their chance of quitting successfully and the benefits start straight away, with carbon monoxide levels in the blood dropping to normal after twelve hours.

With World No Tobacco Day coming up this Thursday, now could be the moment to quit.


Sørensen LT. 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):373-383. doi:10.1001/archsurg.2012.5

Quit website: NHS Smokefree; WhyQuit

World Health Organisation World No Tobacco Day 2012 and Quitting Tobacco

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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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