Surgery patients are routinely advised to quit smoking before
their operation, and previous research has shown that abstinence
from smoking can reduce post-op complications, including wound
infection. However, exactly how long abstinence must be maintained
to produce a benefit has been unclear.
To investigate, Dr. Lars Tue Sorensen and colleagues, from
Bispebjerg University Hospital in Copenhagen, studied the healing of
small incisions in 78 volunteers. Some were habitual smokers and
some had never smoked.
Half the smokers were allowed to continue smoking while the
others abstained from smoking using a nicotine or placebo patch.
After 1 week and again at 4, 8, and 12 weeks later, small
suture-closed incisions were made on the smokers. For comparison,
among most of the never-smokers an incision was made at only one of
those time points.
Wounds became infected in 12 percent of smokers, significantly
more than the 2 percent of never-smokers, the investigators report
in the Annals of Surgery. In addition, wounds broke open in 12
percent of smokers, while no ruptures were seen among never-smokers.
After 4 weeks and again at 8 and 12 weeks, abstinent smokers were
significantly less likely to develop a wound infection than
continuous smokers. Moreover, this benefit did not depend on whether
they quit using a nicotine or placebo patch.
No difference in wound rupture rates was seen between abstainers
and continuous smokers.
Just 4 weeks of abstinence from smoking "reduces wound infections
to a level similar to never-smokers," Sorensen's team concludes.
Two Stanford University physicians point out in a commentary that
these results "suggest that surgeons need to be even more active in
recommending smoking cessation programs to their patients because
the impact of smoking on even minor incisions can be significant."
SOURCE: Annals of Surgery, July 2003.
