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Quitting smoking before treatment: what effect will it have?

Medical Director, Healthcare Management, Bupa Insurance
24 July 2020

If you’re a smoker, perhaps you’ve always intended to stop ‘one day’ but have never quite got around to it. Or maybe you’ve never had enough incentive to make that leap. If you’re preparing to go into hospital for an operation or medical procedure, there is no better time to quit. Smoking increases many of the risks of undergoing surgery. Giving up will increase your chances of a better outcome from your operation, and protect your health into the future.

How will smoking affect my surgery?

All types of surgery carry some level of risk. But if you smoke, you’re more likely to suffer a range of complications both during and after surgery. In fact, the risks from smoking can be so great that in some instances, surgeons won’t carry out a procedure until the patient is able to stop smoking. If you smoke, you’re more likely to:

  • develop airway, lung and heart complications
  • get infections after surgery
  • have delayed wound healing
  • need to stay in hospital for longer, requiring higher doses of medicines
  • be admitted into intensive care
  • be re-admitted as an emergency, after you’ve been discharged

These negative effects are relevant to a wide range of different types of surgery. These include joint replacement surgery (eg, hip replacement and knee replacement), bowel resection surgery, and reconstructive plastic surgery following breast cancer surgery. In fact, any procedure where you’ll need a general anaesthetic will be affected by smoking. If you smoke, you’re more likely to need a higher dose of anaesthesia than someone who doesn’t. You’re also more likely to cough during anaesthesia and recovery, and to experience airway and breathing problems.

When should I aim to give up?

Stopping smoking at any point before surgery will be beneficial. But the sooner you give up, the greater the benefit you’re likely to see. You’re likely to get the most benefit if you quit a couple of months beforehand; but at least four weeks is recommended. Try selecting a date, which falls at least two months ahead of your surgery, when you plan to quit. Marking a date in your calendar will help you to plan and feel ready as the date draws nearer.

Don’t forget, with any length of stay in hospital, you won’t be able to smoke while you’re there. All hospital buildings and grounds are smoke free. Putting the time and effort into quitting well before your hospital stay may be easier than dealing with having to abstain from smoking at the time you’re going through surgery.

If you don’t manage to quit as far ahead as you planned, it’s still worth doing so as soon as you can. It’s better to stop smoking at any point before your surgery than not at all. And if you’ve really found it impossible to quit, reducing how much you smoke will at least have some benefit. You certainly shouldn’t smoke on the day of your surgery, as the carbon monoxide inhaled reduces the amount of oxygen in your blood.

Help with giving up

It’s not easy to break the habit, but you don’t have to go it alone. Your surgeon may give you some advice and offer you support to stop smoking in advance of your operation, and direct you to specialist services. You can also contact your GP for advice and help on giving up. If you’ve been unable to give up, they will also support you in reducing the amount you smoke, or temporarily giving up around the time of your surgery.

You may be offered the following to help you stop smoking.

  • Stop smoking medicines, including varenicline and bupropion.
  • Nicotine replacement therapies (NRT). These come as gums, patches, lozenges and mouth or nasal sprays. They can help you to quit, or you can just use them for the duration of your hospital stay.
  • Behavioural therapy. This involves weekly sessions with a counsellor, trained in providing information and practical advice about quitting smoking. They can help you deal with any barriers that may be stopping you from giving up. It might be offered through your GP surgery, pharmacy, hospital, community services or a voluntary group.

A combination of medicines and behavioural therapy is thought to be most effective in helping people to give up. Stop smoking medicines and NRT will always be available in hospital should you need it when you go in.

Giving up long-term

Having surgery may give you the incentive you need to quit – but don’t stop there! If you’ve managed to stop smoking prior to your surgery, you’ve already done the hardest bit. Don’t be tempted to go back to it afterwards; think about all the good that giving up has done you already. Staying smoke free will reduce your risk of complications after your procedure. Stopping smoking will benefit your health, and quitting smoking is also best for those close to you, in the long term.

Dr Helen Hartley
Medical Director, Healthcare Management, Bupa Insurance

    • Joint briefing: smoking and surgery. Action on Smoking and Health, the Royal College of Anaesthetists, the Royal College of Surgeons of Edinburgh and the Faculty of Public Health. www.ash.org.uk, published April 2016
    • Carrick MA, Robson JM, Thomas C. Smoking and anaesthesia. BJA Education 2019: 19(1): 1e6. https://bjaed.org/article/S2058-5349(18)30116-1/pdf
    • You and your anaesthetic. Royal College of Anaesthetists. www.rcoa.ac.uk, published February 2020
    • Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4
    • Smoking: acute, maternity and mental health services. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published November 2013
    • Preparing your body. Royal College of Anaesthetists. www.rcoa.ac.uk, accessed 25 April 2020

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