From the Guidelines
Smoking cessation of at least 4 weeks is crucial before surgery to minimize the risk of wound healing complications and reduce mortality. The impact of smoking on wound healing percentage is significant, with smokers experiencing a substantial delay in healing rates compared to non-smokers 1. This is attributed to the detrimental effects of nicotine and carbon monoxide on blood flow, oxygen delivery, and nutrient supply to damaged tissues. Furthermore, smoking exacerbates inflammation, impairs immune function, and decreases collagen production, all of which are essential for the wound healing process.
Key Factors Affecting Wound Healing in Smokers
- Nicotine-induced vasoconstriction reduces blood flow to damaged tissues
- Carbon monoxide binding to hemoglobin decreases oxygen availability
- Increased inflammation and impaired immune function
- Reduced collagen production
According to the Enhanced Recovery After Surgery (ERAS) Society recommendation 1, smoking cessation of 4 to 8 weeks is necessary to reduce respiratory and wound-healing complications. While the exact impact of smoking on wound healing percentage is not specified, the recommendation emphasizes the importance of smoking cessation in minimizing postoperative complications, including mortality.
Recommendations for Smokers Undergoing Surgery
- Complete smoking cessation at least 4 weeks before surgery
- Abstain from smoking throughout the recovery period
- Even reducing smoking can improve outcomes, but complete cessation provides the greatest benefit
- Heavier smokers are at a higher risk of healing delays and complications, such as infections, wound dehiscence, and tissue necrosis.
From the Research
Impact of Smoking on Wound Healing
- Smoking has been shown to affect wound healing, with studies indicating that it can lead to delayed wound healing, tissue infections, and/or sepsis 2, 3, 4, 5, 6.
- The mechanisms underlying the impact of smoking on wound healing are complex and involve multiple factors, including decreased tissue oxygenation, impaired inflammatory response, and increased formation of neutrophil extracellular traps (NETs) 2, 3.
Mortality and Wound Healing
- While the provided studies do not directly address the impact of smoking on wound healing percentage regarding mortality, they do suggest that smoking can lead to increased complications and impaired wound healing, which may ultimately affect mortality rates 2, 3, 4, 5, 6.
- Smoking cessation has been shown to improve wound healing outcomes, although the effects of nicotine replacement therapy are still unclear 2, 3, 4.
Key Findings
- Studies have consistently shown that smoking is associated with impaired wound healing, with smokers experiencing higher rates of complications and delayed healing compared to non-smokers 2, 3, 4, 5, 6.
- The use of nicotine replacement therapy may not fully address the negative effects of smoking on wound healing, as nicotine and its metabolite cotinine can induce NET formation and interfere with anti-oxidative defense mechanisms 2.