Smoking and hazardous drinking are common and important risk factors for an increased rate of complications after surgery. The underlying pathophysiological mechanisms include organic dysfunctions that can recover with abstinence. Abstinence starting 3-8 weeks before surgery will significantly reduce the incidence of several serious postoperative complications, such as wound and cardiopulmonary complications and infections. However, this intervention must be intensive to obtain sufficient effect on surgical complications. All patients presenting for surgery should be questioned regarding smoking and hazardous drinking, and interventions appropriate for the surgical setting applied.
◊ Reviewed R. Stienstra, MD, PhD
Vice-Chairman,
Dept. of Anesthesiology,
Leiden University Medical Center, Leiden, The Netherlands
Smoking and hazardous drinking are risk factors affecting surgical outcome. This becomes obvious in patients where both have resulted in manifest disease. However, in otherwise healthy patients smoking may affect pulmonary and cardiovascular function, immune response and tissue healing, whereas drinking may affect cardiac function, immune capacity, haemostasis, the metabolic stress response and muscular function.
Impaired wound healing and infection are the most common postoperative complications associated with smoking, whereas for alcohol these are infection, cardiopulmonary complications and bleeding.
The authors underline that patients scheduled for surgery are usually highly motivated to change their habits when confronted with the increased risk of postoperative complications associated with smoking and/or drinking. They also stress the importance of integrating programmes aiming at preoperative cessation of smoking or hazardous drinking in the quality management system of hospitals. |
