18 - Is There an Optimal Timing for Smoking Cessation?

Abstract

Complications of anesthesia are more frequent in patients who smoke, and vary from minor airway events during surgery to inadequate pain control, poor wound healing, and pulmonary complications postoperatively. Many techniques exist to help patients stop smoking, which normally include both pharmacotherapy and behavioral components, and the more intensively these are used, the more likely they are to be successful. The ideal technique for use in the limited time available to preoperative patients is unknown, but cessation advice should always be given because this is a powerful “teachable moment” that may help them stop smoking permanently. Prolonged preoperative smoking cessation for a year or more reduces most complications to the same levels as nonsmokers. Shorter periods of cessation of a few weeks also reduce complications, and the greater the duration, the better. There is no specific duration when cessation is proven to benefit the patient, but multiple analyses suggest statistical significance at around 4 weeks. For major surgery, greater efforts should be made to achieve cessation by the early use of intensive interventions because of the higher risk for complications occurring, but in surgical specialities where postponing surgery may worsen outcomes, the smoking cessation plan should not delay the procedure.