Quitting smoking shortly before surgery poses no complication risk
MedWire News: Patients who quit smoking in the 8 weeks leading up to surgery are no more likely to experience complications than their peers who continue to smoke, results of a meta-analysis demonstrate.
Therefore, "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 presurgical patients at any time," say Katie Myers (Queen Mary University of London, UK) and colleagues.
Cigarette smoking has been implicated as a risk factor for postoperative complications across a spectrum of surgical specialties.
Stopping smoking before surgery can mitigate these risks, and longer periods of preoperative abstinence confer stronger benefits. However, current data do not allow clear advice on an optimal period of preoperative smoking cessation.
"The picture is complicated by a concern that has been circulating over the past 2 decades that stopping smoking within a few weeks before surgery may not just be ineffective in reducing postoperative complications, but that it can contribute to them," Myers et al comment in the Archives of Internal Medicine.
It is possible that the sympathetic activity associated with recent tobacco withdrawal may predispose patients to perioperative cardiovascular or respiratory complications that predominantly occur during the first few days after surgery, they explain.
Alternatively, it may simply indicate that recent quitting is less beneficial than early quitting, not that it is risky.
In the current study, Myers et al identified and analyzed all existing studies that allowed comparisons of postoperative complications in patients who stopped smoking 8 weeks or less prior to surgery (recent quitters) with those who continued to smoke. Two reviewers independently screened potential studies and assessed their methodologic quality.
Nine studies met the inclusion criteria, with one of them finding a beneficial effect of recent quitting compared with continuing smoking, while none identified any detrimental effects.
In meta-analyses, quitting smoking within 8 weeks before surgery was not associated with an increase or decrease in overall postoperative complications for all available studies (relative risk [RR]=0.78), for a group of three studies with high-quality scores (RR=0.57), or for a group of four studies that specifically evaluated pulmonary complications (RR=1.18).
In an accompanying editorial, Clara Chow and Philip Devereaux (McMaster University, Hamilton, Ontario, Canada) said that while the study adds "valuable information" it does not definitively answer the question of smoking cessation timing.
"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," they said.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Andrew Czyzewski