Volume 182 - Issue 1
Smoking cessation and elective surgery: the cleanest cut
Author: Desmond O’Brien
Med J Aust 2005; 182 (1): 44. || doi: 10.5694/j.1326-5377.2005.tb06558.x
Published online: 3 January 2005
Published online: 3 January 2005
To the Editor: Tonti-Filippini condemns denial of elective surgery to smokers as discriminatory.1 He disregards the fact that surgery requires anaesthesia, which may require serious consideration before undertaking non-urgent surgery, and in no way involves discrimination.
He mistakenly regards denying elective surgery to those who continue to smoke as discrimination, in breach of the Hippocratic Oath, and the Australian Medical Association (AMA) Code of Ethics. In fact, to proceed with elective, especially cosmetic, surgery in a heavy smoker is more in breach of the Oath and the AMA Code than not proceeding, for the following reasons.
Smokers are at a significantly greater risk under anaesthesia than non-smokers because, firstly, smoking reduces the capacity of the lungs to take up oxygen, thus increasing the risk of hypoxia and its consequences to heart and brain.2 It also causes coughing and breath-holding during anaesthesia,2,3 creating surgical difficulties, and the risk of error.
Postoperative coughing causes additional pain (especially after thoracic and abdominal operations), and increases the risk of postoperative bleeding, infection, delayed healing and even wound breakdown.4,5
Rather than being discriminatory, delaying elective and cosmetic surgery until he or she stops smoking is very much in the patient’s interests.
References
- Tonti-Filippini NA. Smoking cessation and elective surgery: the cleanest cut [letter]. Med J Aust 2004; 181: 283-284. <eMJA full text>
- Rodrigo C. The effects of cigarette smoking on anesthesia. Anesth Prog 2000; 47: 143-150. i1085628
- Wild MR, Gornall CB, Griffiths DE, Curran J. Maintenance of anaesthesia with sevoflurane or isoflurane: effects on adverse airway events in smokers. Anaesthesia 2004; 59: 891-893. i1085630
- W-Dahl A, Toksvig-Larsen S. Cigarette smoking delays bone healing: a prospective study of 200 patients operated on by the hemicallotasis technique. Acta Orthop Scand 2004; 75: 347-351. i1085632
- Manassa EH, Hertl CH, Olbrisch RR. Wound healing problems in smokers and nonsmokers after 132 abdominoplasties. Plast Reconstr Surg 2003; 111: 2082-2087. i1085634
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