Testing or Trusting? Urine Cotinine Levels in Plastic Surgery

Preoperative laboratory examinations are a common practice throughout all surgical disciplines. Smoking prior to and shortly after elective aesthetic surgery is generally discouraged, but abstinence is rarely examined. Nicotine's major metabolite is cotinine, which is distributed in various body fluids, including blood, saliva, and urine. Urine cotinine levels are a useful short-term marker of nicotine exposure, whether active or passive, and correlate with daily tobacco use. Urinary levels are precise, rapid, easy to examine, and accessible.

The aim of this literature review was to describe the current body of knowledge relevant to cotinine levels in the fields of general and plastic surgery. It was hypothesized that the current available data are enough to support the judicial use of such tests in high-risk surgical candidates, especially in aesthetic surgeries.

A literature review via PubMed was conducted to identify publications that used the terms "cotinine" and "surgery," according to the PRISMA standard flowchart.

After subtracting duplications, the search results yielded 312 papers. After a reduction process as per exclusion criteria, 61 articles were identified and fully reviewed by both authors. Fifteen full-text articles were eligible for qualitative synthesis.

Enough data have accumulated to strongly support the judicial use of cotinine tests prior to elective surgery and specifically in aesthetic surgery.