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Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis - 7/3/2012

Can J Anaesth 2012; 59: 268-79


These authors carried out a literature review to determine the risks or benefits of short-term (less than 4 weeks) smoking cessation on postoperative complications and to derive the minimum duration of preoperative abstinence from smoking required to reduce such complications in adult surgical patients.



The authors searched MEDLINE, EMBASE, Cochrane and other relevant databases for cohort studies and randomised controlled trials that reported postoperative complications (i.e. respiratory, cardiovascular, wound-healing) and mortality in patients who gave up smoking within 6 months of surgery. Using a random effects model, meta-analyses were conducted to compare the relative risks of complications in ex-smokers with varying intervals of smoking cessation versus the risks in current smokers.



A total of 25 studies were included in the analysis. Compared with current smokers, the risk of respiratory complications was similar in smokers who gave up the habit less than 2 or 2–4 weeks before surgery (risk ratio [RR] 1.20; 95% confidence interval [CI] 0.96 to 1.50 versus RR 1.14; CI 0.90 to 1.45, respectively). Smokers who gave up more than 4 and more than 8 weeks before surgery had lower risks of respiratory complications than current smokers (RR 0.77; 95% CI 0.61 to 0.96 and RR 0.53; 95% CI 0.37 to 0.76, respectively). For wound-healing complications, the risk was less in smokers who gave up the habit more than 3 to 4 weeks before surgery than in current smokers (RR 0.69; 95% CI 0.56 to 0.84). Few studies reported cardiovascular complications and there were few deaths.


The authors conclude that at least 4 weeks of abstinence from smoking reduces respiratory complications, and that abstinence of at least 3 to 4 weeks reduces wound-healing complications. Short-term (less than 4 weeks) smoking cessation does not appear to increase or reduce the risk of postoperative respiratory complications.

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