Smoking Cessation Before Surgery Does Not Increase Complications

Stopping smoking a few days prior to surgery is not associated with increased postoperative complications, according to a new study.

Researchers at the Queen Mary University (London, United Kingdom) and the Barts London School of Medicine and Dentistry (United Kingdom) conducted a systematic review and meta-analysis of data extracted from the British Nursing Index (BNI), the Cochrane Library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, and other sources. Studies were included that allow a comparison of postoperative complications in patients undergoing any type of surgery who stopped smoking within eight weeks prior to surgery, and those who continued to smoke.

The results showed that nine studies met the inclusion criteria. One found a beneficial effect of recent quitting compared with continuing smoking, and none identified any detrimental effects. In meta-analyses, quitting smoking within eight weeks before surgery was not associated with an increase or decrease in overall postoperative complications for all available studies, or for a group of four studies that specifically evaluated pulmonary complications. The study was published early online on March 14, 2011, in the Archives of Internal Medicine.

"Existing data indicate that the concern that stopping smoking only a few weeks prior to surgery might worsen clinical outcomes is unfounded,” concluded lead author Katie Myers, MSc, CPsychol, and colleagues. "Further larger studies would be useful to arrive at a more robust conclusion. Patients should be advised to stop smoking as early as possible, but there is no evidence to suggest that health professionals should not be advising smokers to quit at any time prior to surgery.”

Concerns have been expressed that stopping smoking within eight weeks before surgery may be detrimental to postoperative outcomes. This has generated considerable uncertainty even in health care systems that consider smoking cessation advice in the hospital setting an important priority. Smokers who stop smoking shortly before surgery (recent quitters) have been reported to have worse surgical outcomes than early quitters, but this may indicate only that recent quitting is less beneficial than early quitting, not that it is risky.

Related Links:
Queen Mary University
Barts London School of Medicine and Dentistry