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No increased risk detected from smoking cessation just before surgery (Arch Intern Med)


Remember that weird advice we were taught as physicians-in-training to give to smoking patients before an upcoming surgery? “You should quit smoking, but not within the 2 weeks just before your surgery.” (It sounds off-key to me even as I write it now.) Based on … what? Some medical lore passed down from a decades-old study none of us ever actually read?
I always thought that counsel sounded fishy. Apparently, according to a few smart people who looked at the actual evidence, it was.
In a literature review and meta-analysis (actually 3 meta-analyses), Myers et al examined 9 studies and found no evidence of increased complications (pulmonary or otherwise) associated with quitting smoking within 8 weeks before surgery of any kind. They include, and debunk, the 1989 cohort study that birthed the dogma that just-quit smokers are at increased risk for post-op pulmonary complications. That paper in fact did not show a statistically significant difference in complication rates between continuing smokers and just-quit smokers (the salient comparison).
There was wide heterogeneity between studies, hence the 3 separate meta-analyses. Their sensible conclusion: counsel everyone to quit smoking, regardless of surgery timing.

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