Smoking and surgery

Tar, nicotine, and other chemicals from smoking can increase your risk for many health problems. These include heart and blood vessel problems, such as:

• Blood clots and aneurysms in the brain, which can lead to strokes
• Coronary artery disease, including chest pain (angina) and heart attacks
• High blood pressure
• Poor blood supply to the legs
• Problems with erections

Smoking also increases your risk for different types of cancer, including cancer of the:

• Lungs
• Mouth
• Larynx
• Esophagus
• Bladder
• Kidneys
• Pancreas
• Cervix

Smoking also leads to lung problems, such as emphysema and chronic bronchitis. Smoking also makes asthma harder to control.

Some smokers switch to smokeless tobacco instead of quitting tobacco completely. But using smokeless tobacco still carries health risks, such as:

• Developing mouth or nasal cancer
• Gum problems, tooth wear, and cavities
• Worsening high blood pressure and chest pain

Smokers who have surgery have a higher chance than nonsmokers of blood clots forming in their legs. These clots may travel to and damage the lungs.

Smoking decreases the amount of oxygen that reaches the cells in your surgical wound. As a result, your wound may heal more slowly and is more likely to become infected.

All smokers carry an increased risk for heart and lung problems. Even when your surgery goes smoothly, smoking causes your body, heart, and lungs to work harder than if you did not smoke.

Most health care providers will tell you to stop using cigarettes and tobacco at least 4 weeks before your surgery. Stretching the time between quitting smoking and your surgery out to at least 10 weeks can decrease your risk for problems even more. Like any addiction, quitting tobacco is difficult. There are many ways to quit smoking and many resources to help you, such as:

• Family members, friends, and coworkers may be supportive or encouraging.
• Talk to your provider about medicines, such as nicotine replacement and prescription medicines.
• If you join a smoking cessation program, you have a much better chance of success. Such programs are offered by hospitals, health departments, community centers, and work sites.

Using nicotine gum around the time of surgery is not encouraged. The nicotine will still interfere with the healing of your surgical wound and have the same effect on your general health as using cigarettes and tobacco.

Surgery - quitting smoking; Surgery - quitting tobacco; Wound healing - smoking

McEvoy MD, Blitz JD, Borgmeier E. Perioperative medicine. In: Pardo MC, ed. Miller's Basics of Anesthesia. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 42.

Yepuri N, Pruekprasert N, Cooney RN. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 12.

Updated by: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.