Smoking is bad. You know it. I know it. But for this blog I am going to comment on it just for the surgical risk. For those who smoke, please don’t zone out. Read.
A study was published in the general surgery literature. It was a good study on 12,600+ patients in Sweden looking at smoking (and obesity) effect on surgery. Sweden has nationalized health care, so they are able to study many things well. The surgery was an inguinal hernia surgery- small potatoes relative to a lot of what I do as a plastic surgeon. An inguinal hernia is a tiny incision, tiny location, usually an hour surgery, and not a flap.
Findings?
34%
Current smokers had a 34% increased risk of a complication relative to nonsmokers.
We doctors talk talk talk about the negative effects of smoking. But when I talk about this to my patients before surgery, it is for a real reason. Your risk of an issue goes up if you are a smoker. The risk of infection, poor wound healing (and therefore poor scar), wound breakdown, tissue and skin loss, and others. I won’t do certain surgeries on current smokers because the risks are too high. Breast lifts, breast reductions, tummy tucks, and facelifts are all very dependent on blood supply. I specifically address this in my consent. I had one patient at her preop become very agitated – turns out she was a closet smoker, denied it to me, but when she had to sign the consent form and saw in black and white clearly spelled out what smoking does, she knew she couldn’t do the surgery.
How much smoking is ok?
None.
- A history of smoking, even remote, will affect your ability to heal, though some of the ill effects do reverse with time.
- Smoking just on weekends, the “oh I don’t really smoke… oh you know… sometimes I do socially… when I have a few drinks…” is not okay.
- Smoking things other than tobacco is not ok either.
What happens?
Increased infection, poor healing, tissue loss.
Can you give me some good news?
Stopping smoking can reverse some of the bad effects of smoking. If I know you are an ex smoker, I do things more conservatively to try to avoid issues. Honesty is the best practice here. I am not your mom. I am not here to lecture you on the yellow teeth, expense, aging of your skin, etc. I am your surgeon. I am here to work with you to get the best surgical outcome we can.
Hernia. 2007 Apr;11(2):117-23. Epub 2006 Dec 6.
The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery.