Doctors take many factors into consideration when deciding whether or not to perform surgery on a patient. One important factor is whether the patient smokes cigarettes or uses other tobacco products. Smoking can significantly increase the risks associated with surgery and anesthesia. In this article, we will explore how smoking affects surgical outcomes and whether doctors will operate on patients who smoke.
How Does Smoking Affect Surgery?
Smoking affects surgery in several key ways:
Increased Risk of Complications
Numerous studies have shown that patients who smoke have a significantly higher risk of developing complications during and after surgery compared to non-smokers. Some potential complications include:
– Heart and lung problems: Smoking increases the risk of heart attack, stroke, blood clots, pneumonia and other breathing issues.
– Poor wound healing: Smoking impairs circulation and oxygen delivery to tissues, leading to slower and weaker wound healing. This raises the risk of surgical site infections, wound ruptures, and other problems.
– Anesthesia complications: Smokers are more likely to have trouble with anesthesia, including increased risk of breathing problems during surgery.
– Bleeding: Smoking thins the blood and can make bleeding more difficult to control during and after surgery.
– Death: Studies show smokers have a higher risk of dying from complications related to surgery compared to non-smokers. The risk of death can be 2-4 times higher.
Delayed Recovery
In addition to a higher complication rate, smoking also leads to slower and more difficult recovery after surgery. Smokers tend to have:
– Longer hospital stays
– More pain and discomfort
– Slower return to normal activity
– Decreased quality of life measures after surgery
Quitting smoking, even shortly before surgery, can still provide benefits by improving circulation and lung function.
How Long Should You Quit Smoking Before Surgery?
Because smoking has such detrimental effects on surgical outcomes, doctors often advise patients to quit smoking weeks or months before having surgery. But how long should you actually quit?
At Least 4 Weeks
Most experts recommend quitting smoking at least 4 weeks before surgery whenever possible. Studies show that quitting 4-8 weeks prior helps lower the risks of complications significantly.
Even just 4 weeks smoke-free can make measurable improvements in lung function, carbon monoxide levels, circulation and heart rate.
Some specific benefits at 4 weeks include:
– Improved oxygen circulation throughout the body
– Decreased carbon monoxide levels for better heart and lung function
– Reduced blood pressure and heart rate
– Improved wound healing abilities
12 Weeks for Maximum Benefit
Quitting approximately 12 weeks (3 months) before surgery provides maximum benefits and the greatest reduction in surgical risks.
After 12 weeks smoke-free, studies show circulation, lung function, and wound healing improve to near-normal levels. Immune function also rebounds significantly.
Some doctors may recommend quitting even earlier (4-6 months prior) for major surgeries like open-heart procedures. The more time you can be smoke-free, the better.
Will Doctors Operate on Smokers?
Given the increased risks, many patients wonder if doctors simply won’t operate on people who smoke. Here are some general guidelines:
Elective and Minor Surgeries
For minor elective surgeries, like knee arthroscopy or hernia repair, surgeons may ask you to quit smoking first.
Since these are lower-risk planned surgeries, they often have more flexibility on timing and patient optimization before proceeding.
Many surgeons will require smoking cessation 4-8 weeks before elective procedures. They may delay the surgery until you can meet the smoke-free period.
Non-Elective and Emergency Surgeries
For emergency surgeries or major non-elective procedures, surgeons do not always have the option to delay surgery for smoking cessation.
In these cases, whether a person smokes or not often cannot prevent the surgeon from operating.
However, the surgical team will still take extra precautions to optimize the patient as much as possible before surgery. This includes measures like supplemental oxygen, antibiotics, blood thinners and intensive post-operative care.
Informed Consent and Smoking
Surgeons have an ethical obligation to inform patients of any factors like smoking that can substantially increase surgical risks. They will ensure the patient understands the heightened risks of complications.
However, once informed, it is ultimately the patient’s decision on whether to proceed or not. Doctors balance patient autonomy with the imperative to operate, especially for emergency surgeries.
Preparing for Surgery as a Smoker
Here are some tips to prepare for upcoming surgery if you currently smoke:
Quit As Soon As Possible
Quitting well in advance of surgery (at least 4 weeks ideally) can still make a significant difference in lowering risks. Quitting improves your health even in just a few weeks.
Talk to your doctor about smoking cessation aids and programs that can improve your ability to quit now and stay quit after surgery.
Be Open About Your Smoking
Let your surgical team know you smoke as early as possible. Concealing your smoking history can delay or impair the care you receive. The team needs to know your risks to provide the best perioperative care.
Follow Pre-Op Optimization Steps
Your doctors may prescribe medications, breathing exercises, dietary changes and other steps to optimize your health before surgery as much as possible. Follow these diligently to reduce surgical risks.
Ask About Lung Therapy
Pulmonary rehabilitation and lung therapy prior to surgery may improve lung function if you are unable to quit smoking. Discuss options like medications, inhalers, breathing treatments and chest physiotherapy with your doctor.
Arrange Extra Help After Surgery
Since smoking impairs healing, arrange for extra assistance with tasks like shopping, meals and transportation after discharge. Don’t plan on returning to normal activity as quickly. Allow your body adequate rest and recovery time.
Stay Smoke-Free After Surgery
While it can be challenging, it is vital not to smoke at all during the recovery period after surgery. Smoking can damage the healing surgical site and increase the risks of life-threatening post-operative complications.
The Bottom Line
Smoking substantially increases the risks of complications and poor recovery from surgery. Quitting at least 4 weeks prior to surgery can significantly improve outcomes. For non-elective procedures, surgeons will still operate on smokers when necessary, but take extra precautions to optimize their health during the perioperative period. Staying smoke-free after surgery is also critically important. With proper preparation and diligent care, doctors can still successfully perform surgery on smokers when needed.
| Time Quit Before Surgery | Benefits |
|---|---|
| At least 4 weeks | Improved lung function, oxygen circulation, carbon monoxide levels, blood pressure, heart rate |
| 12 weeks | Circulation, lung function and wound healing return to near normal |
References
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