Smoking before surgery: why you need to be careful

Surgery and anesthesia are major stressors to your body. For the best outcome, you want your body to be prepared for the stress. One of the most important ways to prepare your body is to prepare your heart and lungs. This is why smoking before surgery is so serious. Smoking has major effects on your heart and lungs that can cause complications during and after surgery.

Smoking seriously affects the heart, brain, and lungs – the most important organs during surgery.

Why is smoking relevant to surgery?

Surgery can put major stress on the heart, brain, and lungs. Smoking also stresses these organs. Together, smoking can cause serious complications during and after surgery. Given that 1 in 3 patients may smoke before surgery, this can affect many patients.

It doesn’t matter how small or large your surgery is. Smoking can cause serious complications during surgery:

  • Smoking before surgery increases carbon monoxide levels. This can be dangerous during surgery.
  • Smoking results in high nicotine levels, increasing the chance of heart attacks.
    • Nicotine can also reduce wound healing. This can lead to worse scars.
  • Smokers cough up more mucus during surgery. More mucus can cause more infections.
    • Excessive mucus can also cause serious anesthesia complications, like heart attacks and strokes.
    • This is because mucus can clog the breathing tube used while under anesthesia. Clogging the breathing tube prevents oxygen from reaching your lungs. This can damage your organs by asphyxiation.
  • Cigarette smoking directly reduces lung function. Optimal lung function is important to keep your brain and heart safe during surgery.
    • Going under anesthesia reduces lung function. This means any additional “hits” to your lungs, like smoking, can cause added harm. This includes higher risk of heart attacks and strokes.

Smoking before surgery can also worsen scars

Smoking weakens the immune system and tissue healing. The immune system is important to fight infection and heal wounds. These are both crucial after surgery!

In fact, many of my patients take collagen supplements to improve their skin. The thought is that collagen strengthens skin. But cigarette smoking reduces collagen. This is counterproductive to your skin regimen. After surgery, smoking is all the more harmful if you want to minimize scars!

When to stop smoking before surgery

The sooner you stop, the better. Ideally, you want to stop smoking as soon as you know you will be having surgery. It takes 6-8 weeks for the body to begin returning to its pre-smoking health. However, even stopping 1-2 days before can make your surgery safer.

When to start smoking again after surgery

It is best to never start smoking again. As a doctor, I can never say it’s “okay to start smoking again.” To reduce the dangerous complications of smoking after surgery, you should wait several weeks or months.

Quitting before surgery can help you quit for good

Quitting can be very hard. The good news is that many, many patients are able to quit cigarettes smoking for good after surgery! In fact, quit rates can be as high as 89%!

Many patients actually use surgery as their encouragement to quit smoking. Since the risks of smoking are so high during surgery, my patients find new coping skills to stay safe. After surgery, they can use their new coping skills to quit for good.

Many patients are able to quit smoking for good after surgery! In fact, quit rates can be as high as 89%!

Preparing for surgery is the key to putting you in control of your experience. Not smoking before surgery is one of the most powerful things you can do!


Learn more about preparing for the best surgery experience with Dr. Kaveh and subscribe. Remember, the best preparation tool is a personal discussion with an anesthesiologist, tailored to your personal medical history.

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The provided information is not intended as medical advice, simply general educational content.


References

Tønnesen, Hanne. Alcohol abuse and postoperative morbidity. Lægeforeningen, 2002.

Warner MA,  Divertie MB,  Tinker JH. Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients, Anesthesiology, 1984, vol. 60 (pg. 380-3)

Chung F,  Mezei G,  Tong D. Pre-existing medical conditions as predictors of adverse events in day-case surgery, Br J Anaesth, 1999, vol. 83 (pg. 262-70)

Hans P,  Marechal H,  Bonhomme V. Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery, Br J Anaesth, 2008, vol. 101 (pg. 731-7)

Hans P,  Marechal H,  Bonhomme V. Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery, Br J Anaesth, 2008, vol. 101 (pg. 731-7)

Hersey P,  Prendergast D,  Edwards A. Effects of cigarette smoking on the immune system. Follow-up studies in normal subjects after cessation of smoking, Med J Aust, 1983, vol. 2 (pg. 425-9)

Jorgensen LN,  Kallehave F,  Christensen E,  Siana JE,  Gottrup F. Less collagen production in smokers, Surgery, 1998, vol. 123 (pg. 450-5)

Tønnesen, H., et al. “Smoking and alcohol intervention before surgery: evidence for best practice.” British journal of anaesthesia 102.3 (2009): 297-306.

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