Smoking and recovery from surgery

Author: Dr Tony Williams, Consultant Occupational Physician, Working Fit Ltd.

Date: August 2015.

Smoking has multifactorial health effects.  It has specific effects on wound healing (Rinker, 2013).  Inhaled carbon monoxide and hydrogen cyanide both reduce available oxygen, reducing the oxygen available at the wound site (Whiteford, 2003).  Nicotine is a vasoconstrictor, leading to tissue ischaemia and impaired healing, and nicotine adversely affects fibroblasts and macrophages (Silverstein, 1992).

One hundred and twenty women were followed up after laparotomy.  Average scar width in smokers was 7.4mm while for non-smokers it was 2.7mm (p<0.02) (Siana et al., 1989).

One hundred and eighty eight patients were followed up after head and neck surgery.  Those who stopped smoking were divided into ‘early quitters’ who stopped >42 days before surgery, ‘intermediate quitters’ who stopped 22-42 days before surgery and ‘late quitters’ who stopped 8-21 days before surgery.  Impaired wound healing was found in 85.7% of smokers, 68% of late quitters, 55% of intermediate quitters, 59% of early quitters and 48% of non-smokers.  After controlling for other factors, the odds ratio of developing impaired wound healing compared to smokers were 0.31 (95% CI 0.08-1.24) for late quitters, 0.17 (95% CI 0.04-0.75) for intermediate, 0.17 (95% CI for early quitters and 0.11 (95% CI 0.03-0.51) for non-smokers (Kuri et al., 2005).

The risk of incisional hernia is substantially increased in those who smoke.  In a series of 310 laparotomies with an incidence of incisional hernia of 26%, smokers had an odds ratio of 3.93 (95% CI 1.82-8.49) for developing incisional hernia when compared with non-smokers (Sorensen et al., 2005).

Smoking adversely affects bone mineral density, lumbar disc degeneration, the incidences of hip fractures and the dynamics of bone and wound healing (Sloan et al., 2010).

Fifty patients who were smokers were compared to fifty non-smoking patients undergoing two-level laminectomy and fusion.  Examination two years after surgery showed 40% of smokers had developed a pseudoarthrosis whereas the rate among non-smokers was 8% (p=0.001) (Brown et al., 1986).

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