From the Guidelines
The optimal timing for quitting smoking before surgery is at least 4-8 weeks prior to the procedure. This recommendation is based on the most recent and highest quality study, which suggests that smoking cessation of 4 to 8 weeks is necessary to reduce respiratory and wound-healing complications 1. Ideally, patients should stop smoking as soon as they know they need surgery. For maximum benefit, quitting 8 weeks before surgery significantly reduces respiratory complications, while quitting even 24-48 hours before surgery can improve oxygen delivery by reducing carbon monoxide levels in the blood.
Some key points to consider when quitting smoking before surgery include:
- Nicotine replacement therapy (patches, gum, lozenges), varenicline (Chantix), or bupropion (Zyban) can help manage withdrawal symptoms 1.
- Smoking impairs wound healing, increases infection risk, and compromises respiratory function during anesthesia.
- Even brief periods of abstinence improve surgical outcomes by enhancing blood flow, reducing inflammation, and improving immune function.
- Patients should inform their surgical team about their smoking status and any cessation aids they're using, as this may affect anesthesia planning.
It's worth noting that while the optimal timing of cessation remains unknown, an intervention beginning at least 4 weeks before surgery, including weekly counselling and use of nicotine replacement therapy, is the most likely approach to impact complications and long-term smoking cessation 1. Additionally, intense counselling and nicotine replacement therapy are most likely to be effective in the preoperative setting 1.
Overall, quitting smoking before surgery is crucial to reduce the risk of complications and improve surgical outcomes, and patients should be encouraged to stop smoking as soon as possible, with a minimum of 4-8 weeks before the procedure 1.
From the Research
Optimal Timing for Quitting Smoking Before Surgery
The optimal timing for quitting smoking before surgery is a crucial aspect of preoperative care. According to 2, cessation should begin at least 6 to 8 weeks before surgery to reduce the risk of morbidity. However, it is also important to note that some adverse effects induced by nicotine and CO can be restored within 24 to 48 hours of smoking cessation.
Benefits of Quitting Smoking
Quitting smoking can reduce the risk of tobacco-related morbidity and mortality, and potentially gain up to 10 years of life 3. The benefits of stopping smoking are generally accepted, and medical staff should advise patients to quit tobacco use, even in the brief preoperative period 2.
Effective Treatments for Smoking Cessation
Effective treatments for smoking cessation include:
- Combination of medication and behavioral counseling 3
- Nicotine replacement therapy (NRT) products, varenicline, or bupropion 3, 4
- Combining a nicotine patch with other NRT products 3
- Combining drugs with different mechanisms of action, such as varenicline and NRT 3
Postoperative Complications
Studies have shown that quitting smoking shortly before surgery is not associated with an increase or decrease in overall postoperative complications 5. In fact, existing data indicate that the concern that stopping smoking only a few weeks prior to surgery might worsen clinical outcomes is unfounded 5. Patients should be advised to stop smoking as early as possible, but there is no evidence to suggest that health professionals should not be advising smokers to quit at any time prior to surgery 5.
Key Findings
Key findings include:
- Quitting smoking within 8 weeks before surgery was not associated with an increase or decrease in overall postoperative complications 5
- Varenicline and bupropion SR plus intensive counseling can improve smoking cessation and emotional functioning 6
- Varenicline use was associated with a generalized suppression of depression and reduced smoking reward compared with the other treatments 6