Smoking cessation reduces postoperative complications: A systematic review and meta-analysis
Abstract
Objective We aimed to review randomized trials and observational evidence to establish the effect of preoperative smoking cessation on postoperative complications and to determine if there is an optimal cessation period before surgery.Methods We conducted a systematic review of all randomized trials evaluating the effect of smoking cessation on postoperative complications and all observational studies evaluating the risk of complications among past smokers compared with current smokers. We searched independently, in duplicate, 10 electronic databases and the bibliographies of relevant reviews. We conducted a meta-analysis of randomized trials using a random effects model and performed a meta-regression to examine the impact of time, in weeks, on the magnitude of effect. For observational studies, we pooled proportions of past smokers in comparison with current smokers.Results We included 6 randomized trials and 15 observational studies. We pooled the 6 randomized trials and demonstrated a relative risk reduction of 41% (95% confidence interval [CI], 15-59, P = .01) for prevention of postoperative complications. We found that each week of cessation increases the magnitude of effect by 19%. Trials of at least 4 weeks' smoking cessation had a significantly larger treatment effect than shorter trials (P = .04). Observational studies demonstrated important effects of smoking cessation on decreasing total complications (relative risk [RR] 0.76, 95% CI, 0.69-0.84, P < .0001, I(2) = 15%). This also was observed for reduced wound healing complications (RR 0.73, 95% CI, 0.61-0.87, P = .0006, I(2) = 0%) and pulmonary complications (RR 0.81, 95% CI, 0.70-0.93, P = .003, I(2) = 7%). Observational studies examining duration of cessation demonstrated that longer periods of cessation, compared with shorter periods, had an average reduction in total complications of 20% (RR 0.80, 95% CI, 3-33, P = .02, I(2) = 68%).Conclusion Longer periods of smoking cessation decrease the incidence of postoperative complications.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Smoking cessation is the best strategy to attenuate the detrimental influence of cigarette smoking on bone metabolism.
“Smoking cessation is the best strategy to attenuate the detrimental influence of CS on bone metabolism [17].”
From An Overlooked Bone Metabolic Disorder: Cigarette Smoking-Induced Osteoporosis (2022) · cites this paper as [17]
Smoking cessation reduces postoperative complications by about 40%, and the longer the smoking cessation period before surgery, the greater the reduction in complications.
“The analysis found that smoking cessation reduces postoperative complications by about 40%, and that the longer the smoking cessation period before surgery, the greater the reduction in complications.”
From Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic (2021) · cites this paper as [73]
Cites
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
(2014) · Medical Entomology and Zoology · Cited by 17,633 · see citing works
The Health Consequences of Smoking: A Report of the Surgeon General
Office on Smoking (2004) · Cited by 2,414 · see citing works
Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis
Wetterslev, J., Thorlund, K., Brok, J., & Gluud, C. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.03.013 · Cited by 1,881 · see citing works
Review papers : The statistical basis of meta-analysis
Fleiss, J. (1993) · Statistical Methods in Medical Research · doi:10.1177/096228029300200202 · Cited by 1,284 · see citing works
The health consequences of smoking. A report to the Surgeon General: 1971.
Welfare., E. (1971) · Cited by 1,195 · see citing works
Møller, A. M., Villebro, N., Pedersen, T., & Tønnesen, H. (2002) · The Lancet · doi:10.1016/s0140-6736(02)07369-5 · Cited by 1,109 · see citing works
Mortality from smoking worldwide
Peto, R., Lopez, A. D., Boreham, J., Thun, M., Heath, C., & Doll, R. (1996) · British Medical Bulletin · doi:10.1093/oxfordjournals.bmb.a011519 · Cited by 638 · see citing works
Abstinence From Smoking Reduces Incisional Wound Infection: A Randomized Controlled Trial
Sorensen, L. T., Karlsmark, T., & Gottrup, F. (2003) · Annals of Surgery · doi:10.1097/01.sla.0000074980.39700.31 · Cited by 551 · see citing works
Lindström, D., Azodi, O. S., Wladis, A., Tønnesen, H., Linder, S., Nåsell, H., Ponzer, S., & Adami, J. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e3181889d0d · Cited by 530 · see citing works
Effectiveness of smoking cessation therapies: a systematic review and meta-analysis
Wu, P., Wilson, K., Dimoulas, P., & Mills, E. J. (2006) · BMC Public Health · doi:10.1186/1471-2458-6-300 · Cited by 484 · see citing works
Self-citationPreoperative Smoking Habits and Postoperative Pulmonary Complications
Bluman, L. G., Mosca, L. J., Newman, N. B., & Simon, D. G. (1998) · CHEST Journal · doi:10.1378/chest.113.4.883 · Cited by 470 · see citing works
Ambulatory surgery in the United States, 1994.
Kozak, L. J., Hall, M. J., Pokras, R., & Lawrence, L. (1997) · PubMed · Cited by 454 · see citing works
Predictors of Postoperative Pulmonary Complications Following Abdominal Surgery
Brooks, J. A. (1997) · CHEST Journal · doi:10.1378/chest.111.3.564 · Cited by 453 · see citing works
Warner, M. A. A., OFFORD, K. P., Warner, M. E., Lennon, R. L., Conover, M. A., & JANSSON-SCHUMACHER, U. (1989) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(12)65337-3 · Cited by 451 · see citing works
Wilson, K., Gibson, N., Willan, A., & Cook, D. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.7.939 · Cited by 415 · see citing works
The Effect of Cigarette Smoking and Smoking Cessation on Spinal Fusion
Glassman, S. D., Anagnost, S. C., Parker, A., Burke, D. A., Johnson, J. R., & Dimar, J. R. (2000) · Spine · doi:10.1097/00007632-200010150-00011 · Cited by 373 · see citing works
Effect of Smoking on Complications in Patients Undergoing Free TRAM Flap Breast Reconstruction
Chang, D. W.-W., Reece, G. P., Wang, B., Robb, G. L., Miller, M. J., Evans, G. R. D., Langstein, H. N., & Kroll, S. S. (2000) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-200006000-00010 · Cited by 369 · see citing works
Recommendations by Cochrane Review Groups for assessment of the risk of bias in studies
Lundh, A., & Gøtzsche, P. C. (2008) · BMC Medical Research Methodology · doi:10.1186/1471-2288-8-22 · Cited by 352 · see citing works
Smoking Is a Risk Factor for Incisional Hernia
Sørensen, L. T. (2005) · Archives of Surgery · doi:10.1001/archsurg.140.2.119 · Cited by 341 · see citing works
Wound-Healing Risk Factors After Open Reduction and Internal Fixation of Calcaneal Fractures
Abidi, N. A., Dhawan, S., Gruen, G. S., et al. (1998) · Foot & Ankle International · doi:10.1177/107110079801901211 · Cited by 317 · see citing works
Nakagawa, M., Tanaka, H., Tsukuma, H., & Kishi, Y. (2001) · CHEST Journal · doi:10.1378/chest.120.3.705 · Cited by 289 · see citing works
Thomsen, T., Tønnesen, H., & Møller, A. M. (2009) · British journal of surgery · doi:10.1002/bjs.6591 · Cited by 268 · see citing works
Smoking and Timing of Cessation
Barrera, R., Shi, W., Amar, D., Thaler, H. T., Gabovich, N., Bains, M. S., & White, D. A. (2005) · CHEST Journal · doi:10.1378/chest.127.6.1977 · Cited by 263 · see citing works
Mason, D. P., Subramanian, S., Nowicki, E. R., Grab, J. D., Murthy, S. C., Rice, T. W., & Blackstone, E. H. (2009) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2009.04.035 · Cited by 260 · see citing works
Theadom, A., & Cropley, M. (2006) · Tobacco Control · doi:10.1136/tc.2005.015263 · Cited by 252 · see citing works
Preoperative Cessation of Smoking and Pulmonary Complications in Coronary Artery Bypass Patients
Warner, M. A. A., Divertie, M. B., & Tinker, J. H. (1984) · Anesthesiology · doi:10.1097/00000542-198404000-00022 · Cited by 234 · see citing works
Risk of Respiratory Complications and Wound Infection in Patients Undergoing Ambulatory Surgery
Myles, P. S., Iacono, G. A., Hunt, J. O., Fletcher, H., Morris, J. E., McIlroy, D. R., & Fritschi, L. (2002) · Anesthesiology · doi:10.1097/00000542-200210000-00015 · Cited by 200 · see citing works
Kuri, M., Nakagawa, M., Tanaka, H., Hasuo, S., & Kishi, Y. (2005) · Anesthesiology · doi:10.1097/00000542-200505000-00005 · Cited by 199 · see citing works
Complications of Postmastectomy Breast Reconstructions in Smokers, Ex-smokers, and Nonsmokers
Padubidri, A. N., Yetman, R. J., Browne, E. Z., Lucas, A. R., Papay, F. A., Larive, B., & Zins, J. E. (2001) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-200102000-00007 · Cited by 189 · see citing works
Russell, M. A., Stapleton, J., Feyerabend, C., Wiseman, S. M., GUSTAVSSON, G., Säwe, U., & Connor, P. (1993) · BMJ · doi:10.1136/bmj.306.6888.1308 · Cited by 173 · see citing works
Risk Factors and Complications in Free TRAM Flap Breast Reconstruction
Selber, J. C., Kurichi, J. E., Vega, S., Sonnad, S. S., & Serletti, J. M. (2006) · Annals of Plastic Surgery · doi:10.1097/01.sap.0000210180.72721.4a · Cited by 155 · see citing works
Vaporciyan, A. A., Merriman, K. W., Ece, F., Roth, J. A., Smythe, W. R., Swisher, S. G., Walsh, G. L., Nesbitt, J. C., & Putnam, J. B. (2002) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(01)03443-9 · Cited by 150 · see citing works
Sørensen, L. T., & Jørgensen, T. (2003) · Colorectal Disease · doi:10.1046/j.1463-1318.2003.00450.x · Cited by 150 · see citing works
Complications in Smokers After Postmastectomy Tissue Expander/Implant Breast Reconstruction
Goodwin, S. J., McCarthy, C. M., Pusic, A. L., Bui, D. T., Howard, M. A., Disa, J. J., Cordeiro, P. G., & Mehrara, B. J. (2005) · Annals of Plastic Surgery · doi:10.1097/01.sap.0000168282.81348.b3 · Cited by 130 · see citing works
Paoletti, P., Fornai, E., Maggiorelli, F., Puntoni, R., Viegi, G., Carrozzi, L., Corlando, A., GUSTAVSSON, G., Säwe, U., & Giuntini, C. (1996) · European Respiratory Journal · doi:10.1183/09031936.96.09040643 · Cited by 108 · see citing works
Smoking and complications of onlay bone grafts and sinus lift operations.
Levin, L., Herzberg, R., Dolev, E., et al. (2004) · PubMed · Cited by 107 · see citing works
Sørensen, L. T., Hemmingsen, U., & Jørgensen, T. (2007) · Hernia · doi:10.1007/s10029-007-0229-0 · Cited by 77 · see citing works
Smoking cessation in hospital patients given repeated advice plus nicotine or placebo chewing gum
Campbell, I. A., Prescott, R. J., & Tjeder-Burton, S. M. (1991) · Respiratory Medicine · doi:10.1016/s0954-6111(06)80295-7 · Cited by 76 · see citing works
Combination of log relative risk in retrospective studies of disease.
Sheehe, P. R. (1966) · American Journal of Public Health and the Nations Health · doi:10.2105/ajph.56.10.1745 · Cited by 75 · see citing works
Effect of Nicotine Replacement Therapy on Stress and Smoking Behavior in Surgical Patients
Warner, D. O., Patten, C. A., Ames, S. C., Offord, K. P., & Schroeder, D. R. (2005) · Anesthesiology · doi:10.1097/00000542-200506000-00013 · Cited by 72 · see citing works
Agreement between Alternative Classifications of Acute Respiratory Distress Syndrome
Meade, M. O., Guyatt, G. H., Cook, R. J., Groll, R. J., Kachura, J. R., Wigg, M., COOK, D. J., Slutsky, A. S., & Stewart, T. E. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.2.2006067 · Cited by 72 · see citing works
Ambulatory surgery in the United States, 1996.
Mj, H., & Lawrence, L. (1998) · PubMed · Cited by 71 · see citing works
Mills, E. J., Wu, P., Spurden, D., Ebbert, J. O., & Wilson, K. R. (2009) · Harm Reduction Journal · doi:10.1186/1477-7517-6-25 · Cited by 67 · see citing works
Self-citationYamashita, S., Yamaguchi, H., Sakaguchi, M., et al. (2004) · Respiratory Medicine · doi:10.1016/j.rmed.2004.01.011 · Cited by 63 · see citing works
Myles, P. S., Leslie, K., Angliss, M., Mezzavia, P. M., & Lee, L. (2004) · Anaesthesia · doi:10.1111/j.1365-2044.2004.03943.x · Cited by 61 · see citing works
Lavernia, C. J., Sierra, R. J., & Gómez-Marı́n, O. (1999) · Clinical Orthopaedics and Related Research · doi:10.1097/00003086-199910000-00021 · Cited by 60 · see citing works
Risk reduction: Perioperative smoking intervention
Møller, A. M., & Tønnesen, H. (2006) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2005.10.008 · Cited by 58 · see citing works
Acute Smoking Increases ST Depression in Humans During General Anesthesia
Woehlck, H. J., Connolly, L. A., Cinquegrani, M. P., et al. (1999) · Anesthesia & Analgesia · doi:10.1213/00000539-199910000-00008 · Cited by 58 · see citing works
Acute Smoking Increases ST Depression in Humans During General Anesthesia
Woehlck, H. J., Connolly, L. A., Cinquegrani, M. P., et al. (1999) · Anesthesia & Analgesia · doi:10.1097/00000539-199910000-00008 · Cited by 56 · see citing works
Smoking and complications of onlay bone grafts and sinus lift operations
Levin, L., Herzberg, R., Dolev, E., et al. (2004) · Journal of Prosthetic Dentistry · doi:10.1016/j.prosdent.2004.08.009 · Cited by 51 · see citing works
The effectiveness of smoking cessation interventions prior to surgery: A systematic review
Cropley, M., Theadom, A., Pravettoni, G., & Webb, G. (2008) · Nicotine & Tobacco Research · doi:10.1080/14622200801888996 · Cited by 43 · see citing works
Prospective study of skin surgery in smokers vs. nonsmokers
Dixon, A. J., Dixon, M. P., Dixon, J. B., et al. (2008) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2008.08846.x · Cited by 38 · see citing works
Kuper, H., Nicholson, A., & Hemingway, H. (2006) · BMC Medical Research Methodology · doi:10.1186/1471-2288-6-4 · Cited by 36 · see citing works
The influence of alcohol and tobacco use in orthopaedic inpatients on complications of surgery
Williams, G., Daly, M., PROUDE, E. M., et al. (2007) · Drug and Alcohol Review · doi:10.1080/09595230701711108 · Cited by 35 · see citing works
Perisurgical smoking cessation and reduction of postoperative complications
Moore, S., Mills, B. B., Moore, R. D., Miklos, J. R., & Mattox, T. F. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.11.048 · Cited by 33 · see citing works
Taber, D. J., Ashcraft, E. E., Cattanach, L. A., et al. (2009) · Surgical Laparoscopy Endoscopy & Percutaneous Techniques · doi:10.1097/sle.0b013e31819f42f4 · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Sørensen, L. T. (2012) · Archives of Surgery · doi:10.1001/archsurg.2012.5 · Cited by 645 · see citing works
Cigarette Smoking Increases Complications Following Fracture: A Systematic Review
Scolaro, J. A., Schenker, M. L., Yannascoli, S., Baldwin, K., Mehta, S., & Ahn, J. (2014) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.m.00081 · Cited by 279 · see citing works
Hernigou, J., & Schuind, F. (2019) · Bone & Joint Research · doi:10.1302/2046-3758.86.bjr-2018-0344.r1 · Cited by 109 · see citing works
An Overlooked Bone Metabolic Disorder: Cigarette Smoking-Induced Osteoporosis
Weng, W., Li, H., & Zhu, S. (2022) · Genes · doi:10.3390/genes13050806 · Cited by 65 · see citing works
Raichurkar, P., Denehy, L., Solomon, M., Koh, C., Pillinger, N., Hogan, S., McBride, K., Carey, S., Bartyn, J., Hirst, N., et al. (2023) · Annals of Surgical Oncology · doi:10.1245/s10434-023-14192-x · Cited by 53 · see citing works
Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic
Tarantino, U., Cariati, I., Greggi, C., Gasbarra, E., Belluati, A., Ciolli, L., Maccauro, G., Momoli, A., Ripanti, S., Falez, F., et al. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22126629 · Cited by 52 · see citing works
Aspera-Werz, R. H., Ehnert, S., Müller, M., Zhu, S., Chen, T., Weng, W., Jacoby, J., & Nussler, A. K. (2020) · World Journal of Stem Cells · doi:10.4252/wjsc.v12.i8.841 · Cited by 24 · see citing works
- Authors
- Mills, E., Eyawo, O., Lockhart, I., Kelly, S., Wu, P., & Ebbert, J. O.
- Affiliations
- University of Ottawa (CA)
- Pfizer (United Kingdom) (GB)
- McMaster University Medical Centre (CA)
- Mayo Clinic (US)
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2011-02
- Volume
- 124
- Issue
- 2
- Pages
- 144-154.e8
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2022205929
- Cited by
- 599
- References
- 58
- Citations by year
- 2026: 37 · 2025: 53 · 2024: 43 · 2023: 48 · 2022: 53 · 2021: 56 · 2020: 48 · 2019: 48 · 2018: 39 · 2017: 33 · 2016: 31 · 2015: 32 · 2014: 27 · 2013: 22 · 2012: 20
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- smoking cessation, preoperative smoking cessation, postoperative complications, pulmonary complications, former smokers, current smokers, perioperative risk reduction
- MeSH terms
- Humans, Length of Stay, Lung Diseases, Postoperative Complications, Risk Factors, Time Factors, United States, Wound Healing, Randomized Controlled Trials as Topic, Smoking Cessation, Risk Assessment, Observation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
