Nicotine, delivered through traditional cigarettes, vaping, or smokeless tobacco products, is a significant risk factor for anyone undergoing surgery. Medical and surgical teams agree that all forms of nicotine use should be halted well in advance of an operation. Nicotine is a psychoactive chemical and stimulant with powerful physiological effects that interfere with the body’s ability to handle the stress of surgery and recover. Abstaining from its use is recommended medical advice to improve safety and promote a better outcome.
How Nicotine Affects Surgical Outcomes
Nicotine and carbon monoxide impair fundamental biological processes necessary for healing. Nicotine is a potent vasoconstrictor, causing small arteries and blood vessels to narrow. This constriction reduces blood flow to peripheral tissues, starving them of the oxygen and nutrients required for cellular repair.
Carbon monoxide, a byproduct of combustion, reduces the blood’s oxygen-carrying capacity by binding to hemoglobin and displacing oxygen, causing functional hypoxia. The combination of narrowed vessels and deoxygenated blood limits the supply of oxygenated blood to the surgical site. Furthermore, nicotine use suppresses immune function, making the surgical wound more vulnerable to infection and delaying recovery.
Specific Surgical Risks and Complications
The physiological impairments caused by nicotine translate into a higher risk of serious complications during and after surgery. One danger is an increased risk of cardiovascular events, such as heart attack or stroke. Nicotine causes an acute rise in heart rate and blood pressure, increasing the workload on the heart, and promotes a hypercoagulable state that makes blood clot formation more likely.
Patients who use nicotine also face an elevated risk of respiratory complications, including pneumonia and the need for prolonged mechanical ventilation. Damage to the lungs makes it difficult for a patient to clear secretions and recover from anesthesia. Impaired wound healing is another major complication, manifesting as delayed healing, surgical site infections (SSI), or wound dehiscence. These complications often lead to longer hospital stays, increased medical costs, and the need for additional procedures.
Recommended Preoperative Cessation Guidelines
The timing of nicotine cessation is a key factor in mitigating surgical risk; the longer the abstinence period, the better the outcome. For optimal results, surgical guidelines recommend stopping all nicotine use at least four to eight weeks before a planned procedure. Quitting for four weeks or more significantly reduces wound-healing and respiratory complications.
A cessation period of eight weeks or more can reduce the risk of certain respiratory complications by nearly half compared to continued use. Even if the ideal window is not possible, stopping nicotine for a minimum of 24 to 48 hours before surgery provides acute benefits, such as a drop in carbon monoxide levels and reduced cardiac stress. Patients should be honest with their surgical team about their nicotine use to receive the best guidance and support.
Nicotine Replacement Therapy and Postoperative Considerations
Managing nicotine withdrawal symptoms before and after a procedure can be addressed through medical supervision. Nicotine Replacement Therapy (NRT), such as patches, gums, or lozenges, is an effective tool to manage cravings and aid in long-term abstinence. Studies indicate that NRT use in the perioperative period is not associated with an increased risk of adverse outcomes like wound complications, making it a safer option than continued smoking.
However, since NRT still delivers nicotine, a vasoconstrictor, its use must be carefully monitored by the healthcare team. Abstinence should continue well into the postoperative recovery phase to ensure proper healing. Maintaining a nicotine-free environment allows blood flow to fully normalize, providing tissues with the maximal oxygen and nutrient supply necessary for successful surgical wound repair.