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Word of the Day

No harm to stopping smoking shortly prior to surgery

Clinical Question:
Does stopping smoking within a few weeks of surgery increase postoperative complications?

Bottom Line:
Stopping smoking within 8 weeks prior to surgery is not associated with increased postoperative complications. (LOE = 2a-)

Reference:
Myers K, Hajek P, Hinds C, McRobbie H. Stopping smoking shortly before surgery and postoperative complications. Arch Intern Med 2011;171(11):983-989.  [PMID:21403009]

Study Design:
Meta-analysis (other)

Funding:
Government

Setting:
Various (meta-analysis)

Synopsis:
A previous small study suggested that stopping smoking close to a surgery may increase postoperative pulmonary complications due to the loss of the cough-promoting effect of cigarettes (Mayo Clin Proc 1989;64:609-616). This has led to some guidelines recommending stopping smoking at least 8 weeks or more prior to surgery. Investigators searched multiple databases including the Cochrane Library and MEDLINE to identify studies that compared postoperative complications in patients who recently quit smoking (8 weeks or fewer) with those who continued to smoke prior to surgery. Three reviewers independently selected studies for inclusion and assessed study quality. Studies that corroborated self-reported smoking abstinence with biochemical evidence were rated higher in quality. Data from the 9 included studies (n = 889) showed that patients who quit smoking within 8 weeks of surgery have neither increased nor decreased postoperative complications as compared with those who continued smoking. This was also true when only the 3 highest-quality studies were included. In addition, a meta-analysis of the 4 studies that focused specifically on postoperative pulmonary complications had homogeneous results and showed no significantly increased risk in those who recently quit smoking (relative risk = 1.18; 95% CI = 0.95-1.46).

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