Surgery – A Good Time to Quit Smoking

Quitting smoking is just about the best thing anyone can do for their health.

Are there any benefits to smoking, now that it no longer has much sex appeal, and the French have even banned it in the cafes of the Champs Elysees? The only medical benefit of smoking I know of is a reduction in the risk of postoperative nausea and vomiting (PONV). The cause is not certain, but numerous studies have shown this to be true. Although PONV isn’t much fun this is not, I hasten to add, a good reason to take up the noxious weed before your next operation.

No SmokingSmoking creates added risk for people having surgery and anesthesia. For instance, smoking increases your risk of respiratory complications, and your risk of wound infection.

The perioperative period (before and immediately after surgery) creates forced abstinence – try lighting up in the surgical ward these days and you will pretty soon find yourself surrounded by irate nurses, fellow patients and possibly the security staff. So surgery represents a perfect opportunity to quit.

A new meta-analysis (study of studies) in the Canadian Journal of Anesthesia confirms that the preoperative setting represents a “teachable moment”. There were 610 patients in the four studies. About 17.5 % of patients attending the preoperative clinics in these studies stopped smoking – these were the controls. Those patients who attended the clinic and received a smoking cessation intervention had about a 25% chance of stopping smoking at the 3 to 6 month mark. By comparison, in other studies, about 10% of hospitalized patients (non-preoperative clinic patients) are found to have stopped smoking at 3 to 6 months.

So preoperative smoking cessation interventions increased by 60% the chance that patients had quit smoking a few months later. Unfortunately the one study that looked a bit further out found that by 1 year the smoking rates were equal in those who were helped to stop and those who were not. Not surprising perhaps, given how hard it is to quit long term.

Because of the significant long term benefits of stopping however, anesthesiologists may have a role to play in preventive care. The same goes for diagnosing high blood pressure, coronary artery disease and other conditions commonly seen in preoperative clinics.

Smoking cessation programs are widely available and your hospital or surgery center may be able to direct you to such programs. Smoking cessation aids like nicotine patches or gum, and drugs like bupropion can help you through it.

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