Smoking Cessation and surgical complications

Want to prevent 2 million complications of surgery, just in the United States alone? Have smokers quit smoking for at least a month prior to surgery.

In the United States, approximately 8 to 10 million procedures requiring surgery and anesthesia are performed on cigarette smokers each year, out of the estimated 50 million that are performed in total, nationwide. A recent study (click here) estimated that, if all patients were offered a smoking-cessation intervention before surgery, and assuming a 25% cessation rate, this could result in 2 million complications avoided.

The meta-analysis was done by reviewing all of the randomized trials evaluating the effect of smoking cessation on postoperative complications, and performing statistical calculations to examine the impact of time, in weeks, on the magnitude of effect.

Results:
Smokers that quit smoking before surgery had 41% fewer complications. The researchers found that each week of cessation increases the effect by 19%.

Trials of at least 4 weeks’ smoking cessation had a significantly larger treatment effect than shorter trials (P = .04).

Smokers that quit had lower rates of total complications, fewer wound healing complications, and fewer pulmonary complications.

Comment:
In plastic surgery, smoking also can cause higher rates of flap necrosis (where the skin turns black and dies – as shown in the black area of this mastectomy patient). As you might imagine, this is a major problem for patient and surgeon alike, and can result in bad scarring, a poor cosmetic result, and functional problems.

Both cosmetic and reconstructive surgical procedures have been found to be affected by smoking, including: facelifts, tummy tucks, breast reductions, breast reconstructions after mastectomy, microsurgical free tissue transfers, flaps and grafts of many varieties, and finger replantation after trauma.

Even for surgery performed in the head and neck area, where there is usually a very good blood supply, smokers show a 8X increase in wound healing complications, compared to their non-smoking brethren.

There is no safe minimum number of cigarettes that you can sneak before surgery. Even a couple can do you in…

My recommendation is to totally avoid smoking (all kinds) and nicotine (all sources) for two complete months before surgery. This is especially important for facelifts, tummy tucks and breast lift surgeries.

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