Postoperative Complications Not Influenced by Stopping Smoking Shortly Before Surgery

A report published online today that will appear in the July 11 print issue of Archives of Internal Medicine, one of the JAMA/Archives journals says a meta-analysis of nine previous studies found that quitting smoking shortly before surgery was not associated with an increased risk of postoperative complications. "Cigarette smoking has been implicated as a risk factor for postoperative complications across a spectrum of surgical specialties," the authors provide as background information. "Compared with nonsmokers, smokers who undergo surgery have longer hospital stays, higher risk of readmission, are more likely to be admitted to an intensive care unit, and have an increased risk of in-hospital mortality." They add that existing data do not provide clear advice on an optimal period for a patient to quit smoking before a surgical procedure.

To determine whether there is any evidence that stopping smoking within eight weeks before surgery is associated with postoperative complications, Katie Myers, M.Sc., C.Psychol., and colleagues from Queen Mary University of London, Barts and The London School of Medicine and Dentistry, analyzed existing studies through a search of the medical literature. They found nine studies that met their inclusion criteria comparing post-operative complications in patients who stopped smoking eight weeks or less prior to surgery with those who continued to smoke.

"Only one of the nine included studies reported a significant result, and this was in favor of recent abstainers. When all nine studies are combined, there is no beneficial or detrimental effect of quitting within eight weeks before surgery compared with continued smoking," the authors report. However, they stress the findings need to be interpreted with caution.

"Future studies should focus on patients with a very short duration of abstinence and should use biochemical validation of self-reported abstinence. In the meantime, until some new evidence of harm emerges, firm advice to stop smoking and an offer of smoking cessation treatment to those who need it can be provided to pre-surgical patients at any time," the authors conclude.
(Arch Intern Med. doi:10.1001/archinternmed.2011.97. Available pre-embargo to the media at www.jamamedia.org)

Editor''s Note: Co-authors Drs. Hajek and McRobbie have received research funds from and provide consultancies to the following manufacturers of smoking cessation medications: Glaxo SmithKline, Novartis, Pfizer Global, and Johnson & Johnson. Please see article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: The Optimal Timing of Smoking Cessation Before Surgery
In an accompanying editorial, Clara K. Chow, M.B.B.S., Ph.D., and P.J. Devereaux, M.D., Ph.D., from the Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada, write that "while the review performed by Myers et al provides valuable information, it does not definitively answer the question raised."

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‘Physicians should ideally try to get their patients to stop smoking several months prior to their surgery. The appropriate advice regarding the optimal timing of smoking cessation for patients seen close to their scheduled surgery awaits further research. The magnitude of the problem (i.e., upwards of 70 million adult smokers worldwide undergo major surgery annually) highlights the need for large, high-quality, perioperative tobacco use studies."
(Arch Intern Med. doi:10.1001/archinternmed.2011.88. Available pre-embargo to the media at www.jamamedia.org)

Editor''s Note: Please see article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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