Impact of short duration smoking cessation on post-operative complications: A systematic review and meta-analysis

Use of tobacco poses significant health risks, particularly in surgical patients, where smoking is a well-established risk factor for postoperative complications. Patients are often seen in the pre-assessment clinic 2-4 weeks prior to surgery, presenting a window of opportunity to intervene. The objective of our systematic review and meta-analysis is to explore the impact of short-term smoking cessation on postoperative outcomes, focusing on the critical 2-4-week period preceding surgery.

Systematic review and meta-analysis.

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews.

Adults undergoing surgical procedures with a defined smoking cessation pre-operative smoking cessation interval.

Post-operative complications including pulmonary complications, surgical site infection, wound complication, bleeding, mortality, and composite complications.

Fifty-five studies were included in the systematic review and meta-analysis. Pulmonary complications were more prevalent in former smokers compared to non-smokers, even after cessation. Progressively longer smoking cessation periods showed improved outcomes. Compared to active smokers, preoperative cessation reduced pulmonary complications by 27 % at ≥2 weeks (RR 0.73, 95 % CI 0.60-0.89), 29 % at ≥4 weeks (RR 0.71, 95 % CI 0.61-0.82), and 37 % at ≥8 weeks (RR 0.63, 95 % CI 0.41-0.95). With ≥4 weeks of cessation, there was a 33 % lower risk of wound complications (RR 0.67, 95 % CI 0.47-0.94), 31 % lower risk of composite complications (RR 0.69, 95 %CI 0.63-0.76), and 14 % lower risk of mortality (RR 0.86, 95 % CI 0.77-0.97). Short term cessation did not seem to have a significant impact on surgical site infections or bleeding.

Short term cessation of at least 2-4 weeks demonstrates benefits in reducing post-operative complications.