Quitting smoking before and after surgery reduces complications and improves healing, even if you stop smoking for a few weeks
Smoking or vaping nicotine () exposes the body to carbon monoxide, nicotine and fine particles that reduce oxygen transport and harm the respiratory epithelium. In practice, this translates into a greater risk of pulmonary complications during and after the operation, such as hypoxia, the need for reintubation, as well as slower healing, dehiscence (opening of stitches) and infections. Studies show that stopping smoking a few weeks before surgery significantly reduces these complications.
How long before it is ideal to stop smoking
The recommendation is simple: the sooner, the better. Classic reviews of the literature indicate that 4 weeks without smoking already reduces respiratory and surgical wound complications, while 8 weeks bring even greater benefits. It is important to demystify the idea that quitting at the last minute is harmful — the best evidence shows that any period of time without smoking helps, even just a few days. International guidelines, such as the ERAS protocol for colorectal surgery, recommend starting cessation at least 4 weeks in advance, accompanied by behavioral support and nicotine replacement.
After surgery, maintaining abstinence is essential
Remaining smoke-free post-operatively reduces the risk of wound infection, dehiscence and respiratory complications. The first 4 to 12 weeks are especially critical for healing and preventing relapse. Programs started in the hospital and maintained after hospital discharge increase the chances of success within a year.
Structured interventions significantly increase success rates. The combination of motivational counseling with frequent monitoring (including remote) is effective both pre- and post-operatively. Among the available resources, the following stand out:
- Nicotine replacement therapy (patch, gum, lozenge, inhaler): reduces withdrawal symptoms and is safe in surgical patients.
- Varenicline: medication that acts on nicotinic receptors, reduces the pleasure of smoking and helps control cravings.
- Bupropion: antidepressant that also acts on smoking cravings and can be combined with other resources.
The choice must be individualized, considering the patient’s clinical history and preferences, with medical supervision to ensure safety in the surgical context.
Urgent and oncological surgeries require extra attention
If the surgery is urgent, it is still worth stopping immediately — even a few hours without smoking improves oxygen transport. The recommendation is not to smoke on the day of surgery and to use quick-release nicotine to control the craving. In oncology surgeries, care must be even greater: studies indicate a 31% increase in complications when the patient smoked in the 4 weeks before the procedure, compared to those who stopped smoking beforehand.
Stopping makes a difference — and it starts today
Quitting smoking protects surgery, speeds recovery and improves quality of life. A well-structured plan with the medical team, including NRT, varenicline and/or bupropion, increases the safety and success of abstinence. Even in emergency surgeries, stopping smoking on the day of the procedure already brings important physiological gains. And, post-operatively, maintaining abstinence is decisive for a good result.
Antonio Couceiro Lopes (CRM 100656 SP | RQE 26013)
Digestive system surgeon and member of Brazil Health
