Panelists discussed new findings describing the impact of cigarettes, vaping, and marijuana use on surgical outcomes during a session presented Tuesday, October 6, during the American College of Surgeons (ACS) virtual Clinical Congress 2020.
“Studies show smoking and vaping before an elective operation doubles the risk of postoperative pneumonia and increases the risk of a heart attack by 70 percent,” said Jonah Stulberg, MD, PhD, MPH, FACS, a moderator of the session titled When and How to Quit Cigarettes, Vaping, and Marijuana Use Prior to Surgery. “Smoking remains a large public health problem,” said Dr. Stulberg, a general surgeon and health services researcher at Northwestern Memorial Hospital, Chicago. “Evidence shows all patients should quit before their procedure.”
The session will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.
“If you are inhaling anything at all, it increases the risk of respiratory complications,” said co-panelist Thomas K. Varghese, Jr., MD, MS, MBBS, FACS, thoracic surgeon, University of Utah, Salt Lake City, and director of the ACS Strong for Surgery program, which focuses on strategies to help patients improve their health and reduce risk factors in preparation for an operation. Strong for Surgery offers toolkits and other educational resources to aid patients in smoking cessation; currently, more than 330 U.S. hospitals participate in the program.
A variety of studies show long-term smoking cessation rates are higher in patients who quit in anticipation of an operation. One study found that 15 percent of smokers who participated in a quit-smoking program before surgery quit by the day of their operation, compared with 4 percent in the control group. One month later, 28 percent had stopped smoking, and after a year, a quarter continued to avoid smoking. While patients should ideally quit smoking as far as possible before an operation, experts assert, quitting any amount of time before surgery is more beneficial than not quitting.
“The time before an operation is a great time to empower patients to take action, improve their health, and reduce their risks,” said co-panelist John O. DeLancey, MD, MPH, a urologist affiliated with The Ohio State University Wexner Medical Center, Columbus.
“Two to three weeks of sustained effort—getting the cigarettes out of your life—helps deal with the physical part of the addiction,” added co-panelist Malcolm M. DeCamp, MD, FACS, chair, division of cardiothoracic surgery and professor of surgery and medicine, University of Wisconsin School of Medicine and Public Health, Madison. “Then you have the operation and the immediate recovery where we can reinforce that and work on the psychological aspects.”
Even in the case of routine procedures, smoking cessation programs can reduce the risk of complications, experts said. For example, a 2018 analysis of patients undergoing elective hernia repair found that non-smokers had a significantly lower risk of complications than smokers.
“The biggest motivation a patient has is that they want their operation to go well,” said Dr. Varghese. “Many patients will do whatever is needed to make sure their surgery is a success. Surgeons can provide their patients with resources to be able to stop smoking and help create the environment that leads to success.”