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Quitting smoking before treatment: what effect will it have?
If you smoke, perhaps you’ve always intended to stop ‘one day’ but have never quite got around to it. 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 does smoking affect 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 some instances, surgery will not go ahead 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
Smoking is a major risk for developing complications after certain surgeries. These include joint replacement surgery such as 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.
Is vaping before surgery harmful?
Vaping is when you inhale nicotine as a water-based vapour. This vapour is created by an electronic cigarette (e-cigarette) or another vaping device. Vapes do not contain tobacco so are less harmful than cigarettes as it is the tobacco smoke that causes harm. Vaping can be an effective way to help people stop smoking.
There’s no evidence to show major concerns associated with vaping when you are due to have surgery. But try to avoid both smoking and vaping if you can. Even e-cigarettes are not risk-free, and the long-term effects of vaping are not yet fully understood.
How long before surgery should I stop smoking?
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’ll likely benefit most if you quit a couple of months beforehand; but at least four weeks before 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 you get closer to the date of your surgery.
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. So this is a good reason to quit well before your 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 shouldn’t smoke on the day of your surgery. The carbon monoxide inhaled reduces the amount of oxygen in your blood. Also you shouldn’t vape either.
Help with giving up
It’s not easy to stop smoking, but you don’t have to go it alone. Your surgeon may give you some advice and offer you support to stop smoking. They can also 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 support you to cut down or temporarily give up smoking. You may be offered the following to help you stop smoking.
- Stop smoking medicines, including 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, they will be 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 the health of others around you in the long term.
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Sources Sources
- Joint briefing: smoking and surgery. Action on Smoking and Health, Royal College of Surgeons of England and Edinburgh, the Royal College of Physicians, The Royal College of Anaesthetists and the Centre for Perioperative Care. ash.org.uk, published April 2023
- Carrick MA, Robson JM, Thomas C. Smoking and anaesthesia. BJA Educ. 2019 Jan;19(1):1-6. doi: 10.1016/j.bjae.2018.09.005
- You and your anaesthetic. Royal College of Anaesthetists. rcoa.ac.uk, published February 2020
- Nicotine vaping in England: 2022 evidence update summary. Office for Health Improvement & Disparities. gov.uk, published September 2022
- Electronic Cigarettes. Action on Smoking and Health. ash.org.uk, published December 2021
- Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;2014(3):CD002294. doi:10.1002/14651858.CD002294.pub4
- Tobacco: preventing uptake, promoting quitting and treating dependence. National Institute for Health and Care Excellence (NICE). nice.org.uk, last updated January 2023
- Preparing your body. Royal College of Anaesthetists. rcoa.ac.uk, last accessed June 2023
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