Smoking Before Surgery Increases Risk of Death

3 reasons smoking makes surgery more risky

doctor holding "stop" sign and cigarette

Learning that you need an operation can be scary, but there’s one anxiety-buster you must avoid before surgery — cigarettes.

Advertising Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“Smoking before surgery puts you at a higher risk for postoperative heart attacks, blood clots, pneumonia and even death,” says general surgeon Kevin El-Hayek, MD. “When I schedule surgery, I tell my patients they should stop smoking right away.”

How smokers, former smokers compare

Even though it’s easier said than done, quitting smoking can make a huge difference in your health and recovery from surgery. In fact, the longer you abstain from smoking, the better your chances of a healthy recovery, says Dr. El-Hayek.

A recent study compared post-surgery risks for 125,000 smokers, 78,000 former smokers (who quit at least a year before surgery) and 400,000 nonsmokers.

In comparing smokers with former smokers, researchers found smokers were:

  • 17 percent more likely to die
  • 53 percent more likely to have serious heart and lung problems

Yet former smokers who had quit at least a year before surgery had no increased risk of death compared to nonsmokers.

There’s less research into the risks of secondhand smoke exposure, but Dr. El-Hayek recommends that patients do their best to avoid cigarette smoke before surgery.

Advertising Policy

3 reasons smoking and surgery are a bad combo

Dr. El-Hayek explains why smoking before surgery is risky:

1. It complicates anesthesia

“The anesthesia team can tell immediately if the patient is a smoker,” says Dr. El-Hayek. Anesthesiologists have to work harder to keep smokers breathing while under anesthesia, fighting against lungs compromised by cigarette smoke. That makes it more likely that bronchodilator medications like albuterol must be used.

2. The heart must work harder

Smoking compromises heart function, putting a patient at a greater risk for heart problems during or after surgery. That same study found smokers had a 77 percent greater risk of heart attack after surgery than nonsmokers.

Advertising Policy

3. Wounds take longer to heal

Carbon monoxide in a smoker’s body robs tissues of the oxygen they need to heal. “The toxins in the blood of smokers also permeate the tissue, which further compromises the healing process,” Dr. El-Hayek says.

Silver lining: motivation to quit

The good news is that an upcoming surgery can be just the motivation a smoker needs to finally kick the habit.

“Surgery is a great time to quit,” says Dr. El-Hayek, who often refers his patients to smoking cessation clinics. “When I talk through the risks of pneumonia, heart attack, and death, it helps patients understand the increased risks they face and highlights how they can improve their outcome.”