Monday, 28 March 2011

"To smoke or not to smoke?" is NOT the question.

"To be, or not to be" is the opening line of William Shakespeare's play Hamlet of the third act, scene one. Hamlet ponders over dichotomy of his options. Even though Hamlet was troubled a lot by his issues, thankfully there is no dichotomy amongst physicians when it comes to smoking cessation. Patients who smoke are told to quit often times by their physicians, nurses, family or friends. Many times it is not successful. Nowhere is the opportunity to quit smoking more evident than when there is a surgery looming on the horizon.
Any surgery compels even a chain smoking die-hard addict to quit. The reason is simple; you can't smoke in a hospital when you are recuperating in the post-operative period. I often take this opportunity to tell patients to quit smoking prior to any operative procedure. In fact a lot of surgeons (orthopedic surgeons, heart surgeons etc) want patients to completely kick off their habit even before they begin to talk about surgery.
Quitting smoking especially if you have ANY lung disease is tremendously beneficial. There is no doubt about that. Stopping smoking helps reduce blood pressure, reduces your stroke and heart attack risk.
The question is when to quit before surgery? few days? few weeks? Months? This seemingly simple question has a surprisingly difficult answer.

A study came out in 1989 from the UK which showed that people who quit smoking immediately before surgery had more issues after the operation than those that had quit long time before2. Thus quitting smoking immediately before surgery carried a poorer outcome for post surgical patients!
In an interesting article that came out in Journal of American medical association (JAMA)1, Myers and her group did analysis of existing smoking trials to look for common patterns emerging from these studies. Nine studies were selected with a pooled patient number of 889.
Results of the study show that there was no change in outcome if you continued to smoke or quit smoking just prior to surgery. This result goes against the earlier work and shows that there is no harm in stopping smoking immediately before surgery. The best benefit is if you have not been smoking for a long time (months to years) prior to surgery.  
So what are you waiting for? To smoke or not to smoke is not the question because it has has an easy answer. DON’T!
1.    Stopping smoking shortly before surgery and post-operative complications. A systematic review and meta-analysis. Katie Myers, Peter Hajek, Charles Hinds and Hayden Mc Robbie. J. Arch Intern Med. 2011 Mar
2.    Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Warner MA, Offord KP, Warner ME, Lennon RL, Conover MA, Jansson-Schumacher U. Mayo Clin Proc. 1989 Jun;64(6):609-16.

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