Smoking and Surgery: What Are the Risks

It is a well-established fact that smoking is hazardous to your health. When looking at smoking and its relation to orthopedic surgery there are numerous impacts that smoking has, impeding bone metabolism, increasing incidence of non-union for fractures, increased rate of post-operative infection and wound healing .

Numerous studies have described that wound healing is impaired secondary to diminished blood supply which causes constriction of the blood vessels in response to the nicotine in tobacco. This can create an environment for infection, chronic open wounds or even worse recurrent hospitalizations and delayed healing form surgery.  Nicotine also contributes platelet aggregation which causes the platelets to stick together and increases the risk for a deep vein thrombosis (DVT) or blood clots. Which after some particular orthopedic surgeries like a total joint replacement, surgical repairs of long bone fractures etc. can already cause an increased risk for the DVT from the surgery or injury alone.

Other considerations to think about in relation to orthopedic surgery and smoking are the impact smoking has on your heart and lungs.  Studies show that there is a direct impact on your bodies function during general anesthesia for orthopedic surgery.  The cardiovascular system and respiratory system are extremely vital to your health and safety during orthopedic surgery.  Blood that is pumped from the heart supplies oxygen to the brain and other vital organs to prevent injury and damage.  The byproducts of smoking have a similar effect to the heart muscle like myocardial ischemia or myocardial hypoxia during increased myocardial work, which could happen during surgery.  But this does not necessarily require that there is a presence of coronary artery disease (CAD).   So smoking does pose an increased cardiac risk for surgery.  Besides potential cardiac complications smoking increases mucus production in the lungs at the same time it also decreases the lungs ability to clear the secretions.  This happens because the smoke destroys the small, hair like structure known as cilia that have wave like movements to clear the mucus and other debris. Smoking also causes narrowing of the airway which can increase the risk for collapse.  Aside from the cardiac risk, smoking also causes an increased risk for pulmonary complications.

To help combat these risks that smoking causes, studies have shown improved outcomes from quitting smoking prior to surgery.  To help with that there are numerous smoking cessations tactics available to patients.  We at Specialty Orthopedic Surgery can help navigate you to smoking cessation either prior to surgery preferably or after surgery whenever you are ready to be serious about your health.

Written by Lauren A. Schwartz NP-C, Nurse Practitioner

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