The Effects of Smoking Tobacco on Surgery

Tue, Jun 5. 2012

by Dr Melissa Natalia Ince,
Member of SVG Med. Association

Patients who smoke tobacco are often advised to quit smoking, at least temporarily, when faced with any surgical procedure or anaesthesia. Do smokers need to quit to positively alter the healing process and decrease post-surgical complications?{{more}}

The impeccable function of the cardiovascular system (the heart) is of paramount importance, coupled with a good respiratory (breathing) system. Simply put, well functioning lungs, along with a good blood supply, increase the oxygenation of the body tissues, promoting vitality and optimal healing.

Nicotine, which is the principal substance found in tobacco, presents two major adverse effects on the circulatory system. First, it increases the retention of carbon monoxide attached to the haemoglobin in the blood, thus decreasing the oxygen supply. The power of the heartbeat is also compromised due to the decline in the amount of oxygen delivered to the rest of the body.

Secondly, nicotine increases the demand for oxygen that the body needs, consequently creating a ‘lose-lose’ situation, where the body can no longer meet the increasing oxygen demands, due to poor circulation and/ or tissue perfusion.

Additionally, nicotine causes an increase in the mucus secretion in the lungs while decreasing the ability of the lungs, to clear these secretions. Furthermore, it causes the small airways of the lungs to become narrowed and more prone to collapse, adding to the prolonged chronic cough and infection, as well as lung complications, which in turn compromise the oxygenation of the blood, and lead to the destruction of the tissues of the lungs.

Complications

Healing

Smoking causes a variety of healing-related complications in addition to slowing down the healing process. Wounds are more likely to get infected if you smoke, and may develop blood clot formation near the sore. Stitches placed by the surgeon at the site of the surgery are more likely to come apart in smokers, raising the chance of poor healing and scars. If there is a skin graft, the chances of failure are greater if you smoke. Cigarette smoking increases the risk of post-surgical healing complications and keeps the patient in the hospital longer. Smoking-related lung problems, like excess mucus, make it more likely to develop a pneumonia during recovery.

Anesthesia

The effects of smoking-related diseases increase both anesthetic risks, as well as risks of complications during surgery and recovery. Conversely, anesthesia is safer and more predictable in non-smokers due to better functioning of the lungs, heart, blood vessels, and nervous systems.

Orthopedics

Smoking increases your risk of developing osteoporosis and weakens bones in several ways – a weakness of bone that causes fractures, which take longer to heal in smokers because of the harmful effects of nicotine on the production of bone-forming cells. Elderly smokers are 30% to 40% more likely to break their hips than their non-smoking counterparts.

After hip replacement surgery, there is an increased chance of blood clots forming in the legs. These clots may travel to the lungs. Smoking increases the chance of these clots forming.

Finally, if smokers quit smoking, the greater the chances are of avoiding surgery-related complications. It is especially important not to smoke on the day of your surgery. It is recommended that patients abstain from smoking for as long as possible before and after surgery, or even quitting entirely.

Continuing to smoke after surgery greatly heightens a person’s risks of complications, such as infections in the surgical incision. In one study, more than half of patients who continued smoking after surgery developed complications, compared with less than 20 percent of those who quit. Fewer complications means: less time in the hospital and a quicker recovery.