HOW TO QUIT BEFORE SURGERY

How is quitting before surgery different from quitting in other situations?

Most of the issues related to stopping smoking in general apply, so you should review that section.

An elective surgical operation gives you motivation to quit by a particular day. Most smokers want to quit, but they have no particular date in mind. They sometimes make it a New Year’s resolution, or try to quit while on holiday, or before their wedding day or on a birthday or on the anniversary of some special occasion, but these are times chosen for no medical reason. The need for a surgical operation gives a very real and definite reason to quit by a specific day, to reduce the risks of anesthesia, help wound healing, and increase the chance of a successful operation. You know your body would prefer to face the challenge of surgery in its best, most smoke-free condition.

Almost all hospitals are smoke-free. You will not be allowed to smoke while in your hospital room. In many hospitals, even the grounds of the hospital and the parking lot are smoke-free, and you have to go across the road and be completely off hospital property before you can smoke legally. If you quit smoking before surgery, you will be prepared for this.

Research has shown that quitting smoking before surgery does not make smokers more anxious. When faced with something that scares you, it makes sense to take the appropriate precautions. People put on a helmet before cycling or motor biking. They wear a seat belt in the car, and a safety harness when working on a roof. Many people are scared about anesthesia and surgery, even though both are now very safe. Stopping smoking before surgery is a way you can take some control of the situation and make it even safer.

You are less likely to get withdrawal symptoms if you quit at the time of surgery. Part of the difficulty with quitting is the internal battle: “Should I stay smoke-free, or should I have a cigarette right now? I’d really love a smoke but…” When people are in a situation where they have no choice, they simply cannot smoke – such as in a submarine, jail or a hospital – there is no choice and so there can be no argument, you just have to get through the situation smoke-free. While you are in hospital you may be getting pain medication or other sedation, which will also reduce your carving for cigarettes.

Your surgeon, anesthesiologist or nurse should be able to arrange for smoking cessation counselling, which is often available in hospital. Many hospitals will also provide nicotine replacement therapy.

Being away from your normal habits also helps. If you have a cigarette with your first coffee of the day, then a day when you are not allowed to eat or drink removes that connection. If you smoke with particular friends, and even if they visit you in hospital, they won’t be allowed to smoke, so that link is broken. If you smoke on the deck at sunset and you are stuck in a hospital bed, that association is missing.

Unfortunately, the reverse is also true. Many patients get back to smoking as soon as they leave hospital and return to their usual diet, revisit old friends and get back into their other normal everyday habits. Try and resist this. While in hospital speak to your friends and family about staying smoke-free when you get home. See if the hospital can help you by setting up counselling or providing a prescription for drugs to help you stop smoking. Many hospitals have a nurse or pharmacist who has a special interest and expertise in helping patients stay smoke-free after surgery.

HOW LONG DO I NEED TO STOP SMOKING FOR?

Ideally, everyone should quit smoking as soon as possible and stay off cigarettes forever. Some people are not ready to make that long term plan, but they would stop smoking for a short period to help get over surgery.

Taking a “Smoking Holiday” is one way to quit smoking. Some people find the idea of never smoking again too much to think about, so they will take a break from smoking for a short time, perhaps by not smoking on Mondays. That way they learn how to go through a day without cigarettes. Once they can do one day, they try for longer periods, maybe two days, and gradually work up until they can manage a week at a time. If you really cannot quit smoking forever at this time, take a “Smoking Holiday” and quit for a short time, until you are over the surgery.

There is no proper scientific research about how long a “Smoking Holiday” should be, but based on general principles and our current knowledge of the effects of cigarettes on wound healing, I suggest;

• If you are mainly concerned about the risks of anesthesia, you could resume smoking 24 hours after surgery. Modern anesthetics wear off very quickly and are effectively gone by then.
• If you are mainly concerned about wound infections and healing, a week is probably enough for the skin to heal over and the body to eliminate any organisms which may have entered during surgery.
• If you have had a bone or joint surgery, bone takes a long time to heal and ligaments take even longer. Six to eight weeks would cover most of the initial healing of a fracture or repair of a surgical incision through bone. One rule of thumb is that if you still need to be in a cast, you should not be smoking. Bones go on remodelling themselves throughout life, breaking down in one area and reforming in another so the process of healing is never 100% complete.
• If you have had major plastic surgery involving a vascular flap the blood vessels supplying the flap will never be quite as good as ones supplying normal tissue in its natural place, but most of the healing will be done in the first six to eight weeks.
• If you have had major vascular surgery, such as coronary artery by-pass grafting, removal of blockages from the arteries of the neck or legs, or repair of an abdominal aneurysm these problems will come back if you continue smoking. You really need to stop smoking for ever.

SMOKING CESSATION MEDICATIONS AND SURGERY

Is it safe to use nicotine replacement treatment (NRT) before and after surgery? Nicotine is certainly one of the poisons in cigarette smoke, and it does increase stress on the heart and reduce bone healing. However, a small and controlled amount of nicotine is better than an irregular nicotine surge with smoking, and it avoids all the other chemicals in cigarette smoke. Therefore, it is safe to use NRT at the time if surgery, and most hospitals permit or encourage its use.

One small issue is that it is important to have an empty stomach before surgery. The use of chewing gum, including nicotine gum, increases the production of acid in the stomach, so many anesthesiologists do not allow the use of gum for eight hours before surgery. There does not seem to be any issues related to the use of bupropion or varenicline before or after surgery, and they do not seem to interact with anesthesia.