When it comes to smoking, many surgeries can aggravate a person’s risk for future complications, some being life-threatening. A recent study, which quantified the importance of doctors educating their patients about cessation programs, showed smokers faced a 30 percent greater risk for health complications following colon surgery.

Non-emergency surgeries, such as preventative colorectal screenings, give doctors the chance to educate their patients about smoking cessation programs. Published in the Annals of Surgery, the researchers’ study built upon prior knowledge that smoking increases a person’s risk for health complications following surgery, adding to it the findings that colorectal surgeries can elevate a person’s risk for pneumonia, infection, blood clots, and kidney failure.

“Elective surgeries are planned, so there’s a built-in window of opportunity for patients to stop smoking beforehand,” Fergal J. Fleming, M.D., lead author of the study and assistant professor in the Department of Surgery at the University of Rochester Medical Center, said in a news release. “We know that stopping smoking even as little as six weeks before a procedure can reduce the risk of complications.” 

Underlying the elevated risk is the effect of smoke inhalation on the body. Introducing smoke into a person’s system causes increased inflammation. Following surgery, a recovering body sees more inflammation and has a harder time fighting it, and over time, too much stress causes the body’s processes to shut down.

Establishing The Risks

More than 47,000 subjects comprised the study, with 26,000 receiving non-emergency surgery for colorectal cancer, 14,000 for diverticular disease, and 7,000 for inflammatory bowel disease. In accordance with the Centers for Disease Control and Prevention’s (CDC) nationwide estimates, 20 percent of participants were smokers. Nineteen percent were ex-smokers, and the rest had never lit up.

The team controlled for physical and lifestyle traits, such as age, body mass index, and alcohol use, among others — eventually finding smokers faced an increased risk for complications of about 30 percent. Heavy users — those who smoked two packs a day for 30 years or more — faced an even greater risk for health problems, including death.

The more long-term upshot to the team’s study is that doctors have more information with which to arm themselves when informing patients about cessation programs. Smoking rates have been declining steadily since the 1960s in the U.S., but recently the trend has slowed almost to a standstill. CDC data shows that 52.4 percent of all adult smokers (23.7 million people) ceased smoking for at least one day in 2010 because they were trying to quit.

Despite this, smoking is still the leading cause of preventable death in the U.S. More than 440,000 people die per year as a result of cigarette smoking, 49,000 of which are related to secondhand smoke. Unfortunately, many addictions aren’t easily cured through simple awareness; addicts need the motivation to quit. It’s for this reason, Fleming said, that doctors stand to gain so much from any increase in data regarding the habit’s risks after surgery.

“Anecdotally, we know that many patients don’t take the opportunity to quit or join a smoking cessation program before surgery,” he said. “We want to find out what motivates patients, how can we make them a major player in their own care, and how can we as physicians do a better job of explaining issues like this to patients.”

 

Source: Sharma A, Deeb A, Iannuzzi J. Tobacco Smoking and Postoperative Outcomes After Colorectal Surgery. Annals of Surgery. 2013.