Nicotine and surgery: a bad combination
Nancy desperately needed a hip replacement, but there was a problem: Her doctor said he wouldn’t perform the procedure unless she quit smoking.
Though she was a little taken aback, Nancy buckled down and kicked the habit. Three months later, she had the surgery and a smooth recovery. She hasn’t gone back to cigarettes.
“I had no idea that nicotine and surgery don’t mix,” she said. “I’m glad my doctor forced the issue.”
The dangers of smoking are well known. It was thought that vaping, which lets the user ingest the nicotine without the accompanying toxins of cigarettes and secondhand smoke, was safer.
But nicotine is nicotine, no matter the form. And there are reasons that surgeons will delay or even deny a procedure if the patient is a user. Is it right? Is it fair? Doctors are divided on the issue.
On the one hand there’s evidence that smokers have more postsurgical complications, particularly the time it takes for a surgical would to heal. But evidence also suggests that most nicotine users heal just fine from surgery, and many doctors believe this form of discrimination is wrong.
Let’s take a closer look at the issue.
In recent years, research has shown that compared to nonsmokers, smokers have a higher chance of surgery-related complications like heart attack, stroke, shock and death. Smoking decreases blood flow, making surgical wounds less likely to close, less likely to heal well and more likely to become infected. Smoking also weakens the immune system, which increases the chance of infection after surgery.
Smokers are more likely than nonsmokers to experience specific complications from all types of surgeries. For example:
• Orthopedic (bone or joint) surgery: bones can take longer to heal.
• Plastic surgery: higher chance of scarring.
• Breast reconstruction surgery: more likely to lose implants.
• Spinal fusion surgery: higher chance of infection and bone fracture.
Vaping is no better. At a 2020 panel discussion with the American College of Surgeons, experts underscored the importance of helping patients stop tobacco, vaping and marijuana use before having an operation.
“Studies show smoking and vaping before an elective operation doubles the risk of postoperative pneumonia and increases the risk of a heart attack by 70%,” said Dr. Jonah Stulberg, a former professor of surgery at Northwestern University, now at the University of Texas.
And Dr. Thomas K. Varghese Jr., a thoracic surgeon at the University of Utah, noted: “If you are inhaling anything at all, it increases the risk of respiratory complications.”
Concerns about potential liability may also make a surgeon think twice about performing procedures on those who smoke or use vaping products.
Leaving aside for a moment the question of ethics — and really, I can see both sides — it’s to your benefit to either entirely quit or pause your intake of nicotine before a surgical procedure. Here are some general guidelines.
Try to stop smoking and vaping four to six weeks before your procedure. Quitting a month or more before surgery can reduce your rate of wound complications by 50%, according to the American College of Surgeons. Of course, quitting permanently has the potential to prolong your life (and save you lots and lots of money!)
Ask for support. Let family and friends know what you’re trying to do and get their help. If they smoke, ask them not to smoke around you. Maybe they can offer some distractions with activities and low-calorie or sugar-free treats to keep your hands and mouth occupied.
Be up front with your anesthesiologist about your smoking/vaping history. It’s important to meet with your anesthesiologist about your smoking and how it might affect your anesthesia care plan, especially if you will be under general anesthesia.
If all else fails, quitting smoking/vaping even the day before your procedure will be to your benefit and lower your risk of complications. This is because your body starts to heal and your heart and lungs begin to work better as soon as you quit. The levels of nicotine and the carbon monoxide that comes with cigarettes begin dropping immediately, improving blood flow and reducing the likelihood of problems.
But try not to wait that long.
Finally, remember that you won’t be able to smoke or vape in the hospital anyway. Having surgery may be just the jump-start you need to quit for good!
• Teri (Dreher) Frykenberg, a registered nurse, board-certified patient advocate and author, is the founder of Nurse Advocate Entrepreneur, which prepares medical professionals to become private patient advocates. Reach her at Teri@NurseAdvocateEntrepreneur.com. Readers with questions about patient advocacy may contact Margo Marasa, owner of Allegiance Patient Advocacy, for a free consultation. Contact her at margo@allegiancepa.org or (773) 732-0762.