Doctors tell their patients to quit smoking before surgery. Following this advice helps pave the way for a safe and uneventful recovery. Smokers face increased risk under anaesthesia, because both heart and lung problems can complicate surgery. How many weeks you refrain from smoking before surgery can also make a huge difference. Not smoking after surgery speeds up recovery and avoids unnecessary post-surgical complications.

Smokers face significantly higher levels of risk compared to non-smokers

Numerous studies have been conducted on how and why smokers face higher levels of risk during surgery.

A recent analysis of data of over 520,000 patients from the American College of Surgeons National Surgical Quality Improvement Program database showed that: ^[1][2]

• Smokers are 38 percent more likely to die after surgery than non-smokers.
• Smokers face twice the risk of developing pneumonia.
• Smokers are 80 percent more likely to have a heart attack and 70 percent more likely to have a stroke.
• Smokers are 30 percent more likely to develop infections after surgery. One researcher concluded in 2002 that  “…smoking [is] the single most important risk factor for the development of postoperative complications”.

Smoking increases risk during surgery because it disturbs the healthy functioning of both the heart and lungs.

Heart problems

The carbon monoxide in cigarette smoke combines with red blood cells and reduces their ability to transport oxygen, which in turn reduces the oxygen supply to the lungs and all other cells. Carbon monoxide makes the heart pump poorly, further reducing the amount of oxygen delivered to the rest of the body. Even worse, nicotine from cigarettes increases the amount of oxygen needed by the body. All these effects work together to compromise your body’s oxygen supply.

Lung problems

Smoking affects the lungs in multiple ways. It increases the amount of mucus secreted, while decreasing the lungs’ ability to clear these secretions. Smoke also causes narrowing of the small airways in the lungs, making them prone to collapse. As a result, the lungs become more susceptible to infection, including chronic cough and other breathing complications. Because smokers’ lungs are more sensitive and reactive, there is also a higher likelihood of bronchospasm and other life threatening complications during anaesthesia.

Multiple studies confirm that smoking increases the likelihood of lung complications after an anaesthetic by as much as six times. Smoking also delays wound healing and may lead to heart problems such as heart attacks.

It matters when you quit

In preparation for surgery, smokers can choose their level of risk. The length of time before surgery you abstain from smoking can make a huge difference to the outcome.

When you smoke, your body sustains short-term impacts and long-term or even permanent damage. All this damage can have a negative impact on your surgery. The increased levels of nicotine and carbon monoxide in your blood are flushed out naturally within a few hours of refraining from smoking.

• If you stop smoking for four hours, the level of carbon monoxide in the blood can halve.
• Not smoking for eight hours prior to surgery will bring the carbon monoxide in the blood down to a safe level.
• Not smoking after surgery helps the blood carry oxygen to tissues that are healing. Ample supplies of oxygen encourage healing, minimise skin necrosis (the dying of cells due to poor blood supply) and help prevent infections. That means those who begin smoking immediately after surgery may have more post-operative complications than those who don’t.

These are the short-term effects. Most surgeons will tell you to give up smoking two to three weeks before the day of the procedure. This is because a smoker’s lungs can take weeks to recover from the damaging effects of cigarette smoke. By giving up smoking six weeks prior to surgery, you can greatly reduce breathing problems that can occur while under anaesthesia.

Your surgeon will also tell you not to smoke for at least two weeks after surgery, three weeks is even better. Not smoking helps ensure reduced levels of cell death, which may occur if a patient continues to smoke during the recovery period.

In most cases, studies show that non-smokers heal and recover much faster and with far less complications than smokers.

How smoking can affect cosmetic procedures

In certain cosmetic procedures smokers stand a higher risk, or lower success rate than non-smokers. Surgeons sometimes refuse to perform procedures—such as relocating blood vessels—that could put smokers at risk. Facelifts, breast reduction, use of tissue flaps (in breast reconstruction, for example) and tummy tucks all fall into this category.

• In tummy tucks and other procedures affecting the abdominal wall, surgeons sometimes do not tighten the abdominal muscles as much as they would for a non smoker: Smokers tend to cough, and this can disrupt abdominal healing.
• Smoking significantly increases complication rates in breast reduction. A study published in the Journal of Plastic, Reconstructive & Aesthetic Surgery in May 2007 showed that 35 percent of smokers encountered wound-related complications after breast reconstruction, compared to just 13 percent of non-smokers. Smokers had a 2.3 times higher overall chance of complications. Smokers were also 3.3 times more likely to develop wound infections and three times more likely to develop necrosis.
• Another study showed that 40 percent of patients who smoked before and after breast reduction surgery displayed impaired healing of the surgical wounds. This is why smoking is a key eligibility criterion for breast reconstructive and breast reduction procedures; and why surgeons may refuse to operate on patients who do not quit smoking beforehand and abstain until after all wounds have fully healed.
• Smokers undergoing facelift procedures face a 13-fold risk of skin necrosis compared to non-smokers. They also face a higher risk of bleeding (hematoma) following surgery.

This does not mean you can safely go on smoking if you are having surgical procedures not mentioned above. In general, being a non-smoker or giving up smoking is a key eligibility criterion for candidacy in all surgical procedures.

If you are a smoker, talk to your surgeon about it

Some surgeons will refuse to perform a procedure on smokers because smoking increases the risks you face during surgery and an complicate the healing process. Because cosmetic procedures are all about improving your looks, and smoking can compromise the success of the surgery, your surgeon would prefer to see you give up smoking.

Your surgeon can refer you to a smoking cessation program. Medicare provides rebates for consultation with registered medical practitioners and for psychological treatment related to smoking cessation. Certain prescription medications that help you quit smoking are subsidised under the Pharmaceutical Benefits Scheme. Over-the-counter nicotine patches and other over-the-counter medications like nicotine lozenges, gum, inhalers and micro tabs are not covered under this scheme.

_{[1] Smoking and the risk of Surgery
[2] Smoking and perioperative outcomes.}