Smoking and Surgery: How Does Smoking Affect Surgery?

Smoking and vaping can cause several different issues because of the nicotine and chemicals in them, but they can also cause issues during or after surgery. If you are having a major surgery, your doctor should talk to you about the risks associated with smoking and surgery.

Key Takeaways:

• Smoking puts a lot of strain on the heart, blood vessels, and lungs, which can be compromised while under anesthesia and after the surgery is completed.
• Nicotine also affects bone-forming cells and can cause broken bones take longer to heal and increase the risk of reinjury.
• The most common complications include poor wound healing, increased risk of site infections, and less-satisfactory surgical results.

What are the Biggest Risks of Smoking and Surgery?

Smoking cigarettes or vaping nicotine-based products can have several adverse affects during and after surgical procedures. The risk of anesthesia-related complications rises with smokers because of how the chemicals and nicotine affect the body. The biggest risks of smoking when it comes to surgery are:

1. Respiratory

Most people know that smoking and vaping damage the lungs and weaken their ability to be resilient. Surgery puts a lot of stress on the body, so immune systems are already weakened. But, smokers and vapers are more likely to develop conditions like pneumonia and bronchitis. In addition, since smokers’ lungs don’t get as much oxygen as healthy lungs, there isn’t as much oxygen being delivered to the surgery sites. This may require patients to need a ventilator after surgery.

2. Heart and Cardiovascular

Nicotine causes vasoconstriction, or the narrowing of blood vessels. With the addition of extra plaque formation from the chemicals present in cigarettes and vapes, this puts the heart and cardiovascular system under a lot of stress to carry out the blood flow necessary for surgery sites to heal correctly. It increases the risk of developing blood clots, which can in turn cause deep vein thrombosis (DVT) or pulmonary embolism (PE) during and after surgery.

3. Musculoskeletal

Smoking increases the risk of bone injuries because of several factors (UCI Health, What smoking does to your bones):

• Smoking reduces the blood supply to the bones and to many other body tissues.
• The nicotine in cigarettes slows production of bone-producing cells, called osteoblasts.
• Smoking decreases the body’s absorption of calcium, which is necessary for vital cellular functions and bone health.
• Smoking affects the balance of hormones, including estrogen, which is needed to build and maintain a strong skeleton in women and men.

This increases the probability that patients will need surgery at all, but also inhibits regrowth and, in some cases, the success of a surgery. Surgeries like spinal fusions, which rely on the vertebrae to heal together, can be compromised by the effects of smoking.

Tips to Help Stop Smoking

Even if it is only temporary, or if you can’t quit completely, curbing the habit before surgery can make all the difference in your recovery. Each cigarette or vape you refrain from before a surgery contributes to a better success rate. The sooner you can quit or curb the habit before a surgery, the better. Work with your doctor to find ways to help quit, even temporarily. Some common methods are:

1. Figuring out what triggers the urge to smoke and adjust your schedule or lifestyle to avoid them.
2. Find a replacement that works for you. Lozenges, gum, patches, or nose sprays will have different rates of success for different people. Don’t get discouraged if one doesn’t work. Keep trying to find something that does!
3. Find a distraction for when cravings hit. Exercise, hobbies, or a support system who will talk to you until it passes are simple, but easy ways to distract yourself.
4. Don’t keep any nicotine products on hand. It can be easy to have an “emergency stash”, but if you know it’s there, it will be more difficult to resist.

FAQs about Smoking and Surgery

1. Why do I need to quit smoking before surgery?

Smoking affects nearly every stage of surgical recovery. Nicotine narrows blood vessels and carbon monoxide reduces the oxygen your blood can carry, which means less oxygen reaches healing tissue. This raises the risk of wound infections, poor wound healing, and complications with anesthesia and breathing. Smokers also have higher rates of blood clots, heart and lung problems after surgery, and longer hospital stays. Procedures involving bone fusion, skin flaps, or reconstruction rely on your body being able to heal properly to be successful.

2. How long before surgery should I stop smoking?

The earlier, the better. Many surgeons recommend stopping at least four to six weeks before the procedure, but even stopping a few days beforehand can help. Carbon monoxide levels drop within about 24 hours, but longer smoke-free periods are linked to bigger reductions in complications. However, if you quit smoking right before a procedure, remember that staying smoke-free for several weeks after surgery is also important for healing.

3. Does quitting smoking apply to vaping, nicotine patches, and other nicotine products?

Yes, most of the time, your doctor may ask you to quit vaping. Nicotine patches or gum that you take to help you quit are usually okay, but you may want to stop before the surgery. Nicotine itself constricts blood vessels, so for surgeries where healing blood flow is critical (like reconstructive or spinal fusion procedures), your surgeon may ask you to avoid all nicotine, including patches and gum. In other cases, nicotine replacement therapy is considered a safer option than smoking and can help you stay quit. Always ask your surgeon which products are acceptable for your specific procedure.

If you or someone you love needs an orthopaedic surgeon in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.