What to Do If You Smoke and Are Having Surgery

The mechanisms behind these risks are well understood. Carbon monoxide from cigarette smoke binds to hemoglobin 200-250 times more strongly than oxygen, reducing the oxygen-carrying capacity of your blood. Nicotine constricts blood vessels, further reducing oxygen delivery to tissues. Together, they create a state of relative hypoxia (low oxygen) — the exact opposite of what your body needs to heal from surgery.

• 🩸 Delayed wound healing: Smokers’ wounds heal 30-50% slower than non-smokers’.
• 🦠 Surgical site infections: Smokers are 2-3x more likely to develop infections at incision sites.
• 📉 Skin graft failure: Smokers have significantly higher rates of skin graft and flap necrosis.
• 🫀 Cardiac complications: Smokers have 2x the risk of heart attack during or after surgery.
• 🫁 Post-operative pneumonia: Smokers are 3-4x more likely to develop pneumonia after general anesthesia.

The body begins to heal almost immediately after you stop smoking. Even a short period of abstinence before surgery yields measurable benefits.

• 📅 12-24 hours after quitting: Carbon monoxide levels drop to near-normal. Blood oxygen levels improve.
• 📅 48-72 hours after quitting: Nicotine and its metabolites (cotinine) begin to clear from the body. Blood vessel constriction begins to reverse.
• 📅 2-4 weeks after quitting: Lung function improves. Coughing and sputum production decrease. Cilia in the lungs begin to recover.
• 📅 4-8 weeks after quitting: Wound healing capacity improves dramatically. Complication rates approach those of never-smokers.

If you cannot quit smoking entirely before surgery, nicotine replacement therapy (NRT) — patches, gum, lozenges — is generally safer than continued smoking. However, you must discuss this with your surgeon and anesthesiologist. Nicotine itself (not just cigarette smoke) affects blood vessel constriction and heart rate.

• ✅ NRT is safer than smoking: NRT delivers nicotine without the carbon monoxide, tar, and thousands of other toxins in cigarette smoke. The carbon monoxide component of smoking is particularly dangerous for surgery.
• ⚠️ But NRT is not risk-free: Nicotine still constricts blood vessels and can affect wound healing, though to a much lesser degree than smoking.
• 📋 Anesthesiologist consultation is essential: Your anesthesiologist needs to know about all nicotine products you are using.
• 🩹 Some surgeons recommend stopping NRT 24-48 hours before surgery: This varies by procedure and individual patient. Follow your surgeon’s specific instructions.
• 📦 Native cigarettes are NOT a substitute for NRT: Switching to native brands (Playfare, Canadian, DuMont) does not reduce surgical risks — they contain the same nicotine, tar, and carbon monoxide as commercial cigarettes.

Canadian hospitals are now 100% smoke-free. You cannot smoke anywhere on hospital property — not in your room, not in the hallways, not in outdoor designated areas (most have removed them). Here’s what to expect:

• 🚭 No smoking on hospital grounds: Provincial laws prohibit smoking on all hospital property, including parking lots and walkways. Fines range from $500-$5,000.
• 💊 Nicotine replacement therapy (NRT) is available: Ask your nurse for nicotine patches or gum. Most hospitals provide free NRT to patients who smoke.
• 😔 Withdrawal management: If you are a heavy smoker, you may experience irritability, anxiety, and cravings. Tell your nurse — there are medications and strategies to help.
• 📋 Be honest about cravings: Your healthcare team is not there to judge you. They need to know if you are experiencing withdrawal so they can help.
• ⚠️ Do not try to sneak a cigarette: Smoking with an oxygen cannula (even if removed briefly) is extremely dangerous. Patients have died from oxygen-fed fires.

Because smokers have reduced blood flow and oxygen delivery to healing tissues, post-surgical wound care is even more critical. Follow these guidelines:

• 🩺 Inspect your incision daily: Look for redness, swelling, warmth, or drainage — signs of infection. Smokers are at higher risk, so don’t ignore early signs.
• 🚑 Report fever, chills, or increased pain immediately: These could indicate infection or dehiscence.
• 🩹 Avoid tension on the incision: Smoking weakens tissue strength. Avoid heavy lifting, straining, or any activity that pulls on your incision.
• 🍎 Nutrition matters: Smokers have lower vitamin C levels (which is essential for collagen production and wound healing). Eat vitamin C-rich foods (oranges, bell peppers, broccoli) or take a supplement after consulting your doctor.
• 💧 Stay hydrated: Proper hydration supports blood flow to healing tissues.
• 📋 Most importantly: DO NOT SMOKE POST-OP: Smoking during the healing period dramatically increases the risk of wound complications, including infection and dehiscence. If you cannot quit entirely, talk to your surgeon about nicotine replacement options.

Many smokers who undergo surgery never pick up another cigarette. Hospitalization is an effective “teachable moment” — a time when the health consequences of smoking become real and immediate. Studies show that smokers who quit around the time of surgery have higher long-term quit rates than the general population.

• 📈 30-50% of smokers who quit before surgery remain abstinent at 12 months. This is significantly higher than quit rates in community-based cessation programs.
• 🩺 The experience of surgery makes the risks tangible. For many smokers, their first heart attack or cancer diagnosis is what finally motivates them to quit. Surgery can be that wake-up call without the heart attack.
• 🩹 Use the NRT bridge: If you quit before surgery using NRT, continue using NRT after surgery as part of a structured cessation plan.
• 📞 Take advantage of hospital resources: Many hospitals offer post-discharge smoking cessation follow-up. Ask your discharge planner.
• 💰 Save money for recovery: If you quit smoking, redirect your cigarette budget ($5,000-7,000 per year) toward your recovery — better food, physical therapy, or even a vacation.

Some smokers consider switching to native cigarettes (Playfare, Canadian, DuMont) before surgery, thinking they might be “less harmful.” This is a dangerous misconception. Native cigarettes contain the same nicotine, tar, and carbon monoxide as commercial cigarettes. The only difference is price — not safety.

• 🫁 Carbon monoxide is the same: Native cigarettes produce the same CO levels as commercial cigarettes. Your blood oxygen levels will be just as compromised.
• 💉 Nicotine content is comparable: Native cigarettes are not “light” or “mild.” They contain similar or higher nicotine levels than commercial brands.
• 🚫 No “harm reduction” for surgery: There is no such thing as a “safer cigarette” for surgical preparation. The only safe number is zero.
• 💰 If you cannot quit, native cigarettes are cheaper: If you are absolutely unable to quit before surgery, native cigarettes at $35-50 per carton are more affordable than commercial brands at $140-180. But this does not reduce your surgical risks — only quitting does.