Data Suggest Preoperative Smoking Cessation Not Harmful

Patients who quit smoking shortly before undergo­ing surgery are not at increased risk of postopera­tive complications, compared with those who continue to smoke, according to a report published online in the Archives of Internal Medicine.

“Until some new evidence of harm emerges, firm ad­vice to stop smoking and an offer of smoking cessation treatment to those who need it can be provided to presurgical patients at any time,” said Katie Myers, M.Sc., of Queen Mary, University of London and her associates.

<[stk -3]>Publication of a study in 1989 with 39 subjects sug­gested that “stopping smoking leads to a decrease in coughing and an increase in sputum production.” Al­though that article did not show a significant effect of smoking cessation on postoperative complications, it has continued to influence routine practice; in fact, some treatment guidelines recommend against smoking cessation in the 2 months prior to surgery “to minimize the increase in pulmonary complications in recent quitters.” <[etk]>

<[stk -2]>Ms. Myers and her colleagues reviewed the literature for all studies that allowed comparisons of postoperative complications in patients who stopped smoking 8 weeks or less before undergoing surgery (recent quitters) and patients who continued to smoke. They then performed a meta-analysis of the nine studies that did so, rating as “high quality” the three studies that also used biochem­ical testing to validate subjects’ self-report of their smok­ing status. These studies involved 889 subjects, including 448 recent quitters and 441 continuing smokers.<[etk]>

<[stk -3]>Only one of the studies showed a significant effect of smoking cessation, and that was in favor of recent quit­ting. When the results were pooled, there was “no ben­eficial or detrimental effect of quitting within 8 weeks before surgery compared with continued smoking.” <[etk]><[stk -2]>The results were the same in an analysis of the three high-quality studies, and likewise when the analysis was restricted to only pulmonary postoperative complications. <[etk]>

“In conclusion, there is currently no suggestion, ei­ther from any single study or from combinations of studies, that quitting smoking shortly before surgery increases postoperative complications,” the investigators said (Arch. Intern. Med. 2011 [doi:10.1001/archintern­med.2011.97]).

The reluctance to allow or encourage smoking ces­sation shortly before surgery is based on unconfirmed assumptions. Only one study in the literature has di­rectly examined mucociliary clearance in surgical pa­tients shortly after smoking cessation, and that study found no significant difference between surgical pa­tients who had recently quit and those who continued to smoke, Ms. Myers and her associates noted.

im, ob               embargoed until 4 pm 3/14

{Copy eds. -- I had to get some of my figures from charts and tables because they weren't in the text of the article. -- mam}

I have checked the following facts in my story:

NA     Drug names and dosages

NA     Lab test values and their units

MM     Nos. are correct and add up, and percentages based on those nos. are correct

MM/ew   Citation

MM/ew     Investigators’ names and affiliations

MM /ew    All other proper names (e.g., clinical trials; geographic, company, and test names)

MM     Investigators’ conflicts of interest and sponsor of study

Best contact number = 301-325-5890; email = The study is limited by its observational nature and by the small number of studies available for review.

Ms. Myers reported no conflicts.

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Patients who quit smoking shortly before undergo­ing surgery are not at increased risk of postopera­tive complications, compared with those who continue to smoke, according to a report published online in the Archives of Internal Medicine.

“Until some new evidence of harm emerges, firm ad­vice to stop smoking and an offer of smoking cessation treatment to those who need it can be provided to presurgical patients at any time,” said Katie Myers, M.Sc., of Queen Mary, University of London and her associates.

<[stk -3]>Publication of a study in 1989 with 39 subjects sug­gested that “stopping smoking leads to a decrease in coughing and an increase in sputum production.” Al­though that article did not show a significant effect of smoking cessation on postoperative complications, it has continued to influence routine practice; in fact, some treatment guidelines recommend against smoking cessation in the 2 months prior to surgery “to minimize the increase in pulmonary complications in recent quitters.” <[etk]>

<[stk -2]>Ms. Myers and her colleagues reviewed the literature for all studies that allowed comparisons of postoperative complications in patients who stopped smoking 8 weeks or less before undergoing surgery (recent quitters) and patients who continued to smoke. They then performed a meta-analysis of the nine studies that did so, rating as “high quality” the three studies that also used biochem­ical testing to validate subjects’ self-report of their smok­ing status. These studies involved 889 subjects, including 448 recent quitters and 441 continuing smokers.<[etk]>

<[stk -3]>Only one of the studies showed a significant effect of smoking cessation, and that was in favor of recent quit­ting. When the results were pooled, there was “no ben­eficial or detrimental effect of quitting within 8 weeks before surgery compared with continued smoking.” <[etk]><[stk -2]>The results were the same in an analysis of the three high-quality studies, and likewise when the analysis was restricted to only pulmonary postoperative complications. <[etk]>

“In conclusion, there is currently no suggestion, ei­ther from any single study or from combinations of studies, that quitting smoking shortly before surgery increases postoperative complications,” the investigators said (Arch. Intern. Med. 2011 [doi:10.1001/archintern­med.2011.97]).

The reluctance to allow or encourage smoking ces­sation shortly before surgery is based on unconfirmed assumptions. Only one study in the literature has di­rectly examined mucociliary clearance in surgical pa­tients shortly after smoking cessation, and that study found no significant difference between surgical pa­tients who had recently quit and those who continued to smoke, Ms. Myers and her associates noted.

im, ob               embargoed until 4 pm 3/14

{Copy eds. -- I had to get some of my figures from charts and tables because they weren't in the text of the article. -- mam}

I have checked the following facts in my story:

NA     Drug names and dosages

NA     Lab test values and their units

MM     Nos. are correct and add up, and percentages based on those nos. are correct

MM/ew   Citation

MM/ew     Investigators’ names and affiliations

MM /ew    All other proper names (e.g., clinical trials; geographic, company, and test names)

MM     Investigators’ conflicts of interest and sponsor of study

Best contact number = 301-325-5890; email = The study is limited by its observational nature and by the small number of studies available for review.

Ms. Myers reported no conflicts.

********* UNDERSET  1  LINES *********

Patients who quit smoking shortly before undergo­ing surgery are not at increased risk of postopera­tive complications, compared with those who continue to smoke, according to a report published online in the Archives of Internal Medicine.

“Until some new evidence of harm emerges, firm ad­vice to stop smoking and an offer of smoking cessation treatment to those who need it can be provided to presurgical patients at any time,” said Katie Myers, M.Sc., of Queen Mary, University of London and her associates.

<[stk -3]>Publication of a study in 1989 with 39 subjects sug­gested that “stopping smoking leads to a decrease in coughing and an increase in sputum production.” Al­though that article did not show a significant effect of smoking cessation on postoperative complications, it has continued to influence routine practice; in fact, some treatment guidelines recommend against smoking cessation in the 2 months prior to surgery “to minimize the increase in pulmonary complications in recent quitters.” <[etk]>

<[stk -2]>Ms. Myers and her colleagues reviewed the literature for all studies that allowed comparisons of postoperative complications in patients who stopped smoking 8 weeks or less before undergoing surgery (recent quitters) and patients who continued to smoke. They then performed a meta-analysis of the nine studies that did so, rating as “high quality” the three studies that also used biochem­ical testing to validate subjects’ self-report of their smok­ing status. These studies involved 889 subjects, including 448 recent quitters and 441 continuing smokers.<[etk]>

<[stk -3]>Only one of the studies showed a significant effect of smoking cessation, and that was in favor of recent quit­ting. When the results were pooled, there was “no ben­eficial or detrimental effect of quitting within 8 weeks before surgery compared with continued smoking.” <[etk]><[stk -2]>The results were the same in an analysis of the three high-quality studies, and likewise when the analysis was restricted to only pulmonary postoperative complications. <[etk]>

“In conclusion, there is currently no suggestion, ei­ther from any single study or from combinations of studies, that quitting smoking shortly before surgery increases postoperative complications,” the investigators said (Arch. Intern. Med. 2011 [doi:10.1001/archintern­med.2011.97]).

The reluctance to allow or encourage smoking ces­sation shortly before surgery is based on unconfirmed assumptions. Only one study in the literature has di­rectly examined mucociliary clearance in surgical pa­tients shortly after smoking cessation, and that study found no significant difference between surgical pa­tients who had recently quit and those who continued to smoke, Ms. Myers and her associates noted.

im, ob               embargoed until 4 pm 3/14

{Copy eds. -- I had to get some of my figures from charts and tables because they weren't in the text of the article. -- mam}

I have checked the following facts in my story:

NA     Drug names and dosages

NA     Lab test values and their units

MM     Nos. are correct and add up, and percentages based on those nos. are correct

MM/ew   Citation

MM/ew     Investigators’ names and affiliations

MM /ew    All other proper names (e.g., clinical trials; geographic, company, and test names)

MM     Investigators’ conflicts of interest and sponsor of study

Best contact number = 301-325-5890; email = The study is limited by its observational nature and by the small number of studies available for review.

Ms. Myers reported no conflicts.

********* UNDERSET  1  LINES *********