Richard Bloom - December 12, 2011

Smoking & Surgery?

By Richard Bloom, Plastic Surgeon -

A number of my plastic surgery colleagues and I will not perform elective surgical procedures on patients that smoke.  This may sound a little harsh, but the hard facts are smokers have a higher risk of serious complication during and after surgery.  Surgery in itself is stressful on the body, without the added health risks caused by smoking.

For example, a body lift operation performed on a massive weightloss patient already has its challenges – six to eight hours on the operating table; the average removal of three to five kilograms of skin; large wounds; four days in hospital; and recovery at home before returning to normal activities. Good surgical planning, execution and post-operative management reduces the risk of complication. Adding smoking into the equation only further complicates the situation as the patient is more likely to

  • starve their heart of oxygen
  • form blood clots in their veins
  • find it harder to breathe during and after surgery
  • increase their risk of infection
  • impair the healing of skin and wounds
  • change the breakdown of certain drugs in their body

Quit describes the effects of smoking on the body very well.

Nicotine in cigarette smoke increase your heart rate and blood pressure, making your heart work harder so that it needs more oxygen. Carbon monoxide in cigarette smoke competes with the oxygen in your blood.  This makes it harder to get the oxygen you need for your heart and body. Chemicals in cigarette smoke make your blood thicker, stickier and more likely to clot.

Chemicals in cigarette smoke can paralyse and destroy the cilia in your lungs which work to keep your lungs clear. Smoking increases the amount of mucus in your lungs, and narrows your airways. It increases the likelihood that your airways and air sacs in your lungs will partially collapse, making it harder to breathe.

Smoking alters your immune system and you will have a higher risk for chest and wound infections after surgery. Smoking can slow down and interfere with the healing of bones, skin and other body tissues.  You are more likely to have wound infection after surgery, longer healing times, problems with new scars opening up and bad scarring.  Chemicals in cigarette smoke interfere with the rate at which certain drugs break down in your  body.

Ideally, it would be best if the patient gave up smoking entirely. If not permanently, then I recommend stopping at least six weeks before surgery. The benefits will be evidenced by a faster recovery; better wound healing; a shorter stay in hospital and the reduced need for further surgery due to complications. The patient’s rate or extent of recovery may also depend on other things such as whether their already have an advanced smoking-related
illness.

After surgery, it is important that the patient does not start smoking again for as long as possible. They need to allow their body sufficient time to recover and heal properly.

For more information about stopping smoking visit http://www.quit.org.au/ or see your general practitioner.

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