The effects of smoking on postoperative recovery

Two recent studies have implicated smoking as a principal risk factor for increasing the time patients spend in the postanesthesia care unit (PACU) following a wide range of surgical procedures. Hospitals are performing an increasing number of surgical procedures, with growing pressure to do more on an outpatient basis. With more internal and external pressures to streamline the rising costs of medical care, increased focus is being placed on the length of stay in the PACU. More than 300 patients were examined in each study. PACU time varied from 15 minutes to 5 hours, with a median of 75 minutes. Anesthesia duration correlated most closely with the length of stay in the PACU. All other variables were found to be unrelated to the length of time in the PACU or secondary to anesthesia time. The only independent factor was a history of smoking. While there were comparable ratios of smokers in all tested groups, there was a marked difference between smokers and nonsmokers in length of PACU stay. Of the nonsmokers, 38% were found to have PACU stays of less than 1 hour, compared with 23% of the smokers. Only 7% of the nonsmokers required longer PACU stays, compared with 19% of the smokers. Among the various smoking groups, however, there were no significant differences. While previous studies have suggested that smokers may have higher rates of various perioperative complications, these two studies are significant in that they have identified a population previously overlooked. These people who stay longer in the PACU would not otherwise be identified as having complications, and their eventual outcome was good. But it suggests that even these patients, who may view themselves as "healthy smokers," are significantly different from their nonsmoking counterparts. Further, varying the degree of smoking from heavy to light does not negate the increased PACU time. Therefore, any degree of smoking must now be viewed as having serious consequences in the immediate postoperative period and must be discouraged.