This article is more than 5 years old. Information may no longer be current.
Having patients stop smoking before and after surgery is a needed protocol
Click Here to Manage Email Alerts
In the last decade, smoking has received much attention concerning its negative influence on health, especially cardiovascular disease and cancer. Today, in more European nations, lung cancer has surpassed breast cancer as the most frequent cause of death from cancer in women. As a result, several nations have instituted regulations banning smoking in public and private spaces.
At the same time, smoking as a health issue has also gained increased attention within the orthopaedic community. It is clinically documented that smoking increases the risk of nonunion in long bone fractures and after spondylodesis surgery performed with bone graft. More research should be done to thoroughly document the negative effect of smoking on all aspects of orthopaedic surgery. We need such evidence to both instruct our patients on how to stop smoking and to protect our careers.
Ethical dilemma
Therefore, I wonder if we, as orthopaedic surgeons today, can ethically deny surgery to someone who is a heavy or mild smoker should they refuse to stop smoking prior to their intervention. In my opinion, we can and we should.
We must convince our patients that smoking may increase the risks associated with surgery significantly and give them clear examples of the complications that may result, such as wound healing issues, long-term drainage from surgical sites and an increased risk of surgical site infection. Then, if our patients still refuse to participate in smoking cessation, there should be a way that we can legally deny surgery to such individuals with the argument being that smoking cessation both helps prevent complications and keeps increased costs in check for patients, hospitals, health services and the community.
Furthermore, no surgeon wants in any way to condone practices that may increase the risk of complications for their patients.
My main concern at the moment is the behavior of patients after they leave the hospital. If they start smoking immediately postoperatively and to the same extent that they smoked preoperatively, then I wonder how that will impact the aforementioned complications. How can we perhaps document the complications that have occurred after hospital discharge that we believe are due to a patient smoking again? Is the fact the patient resumed smoking arguable and provable in a medical malpractice case or lawsuit initiated by the patient after a procedure fails or he or she develops an infection or nonunion?
Lead the way
Orthopaedic surgeons and the orthopaedic community must lead the way in this area. We need to use the media and other efforts to globally inform patients, authorities and insurance companies that we believe smoking is a hidden “killer.” It not only causes cancer, but it results in morbidity and complications after minor and major orthopaedic procedures.
Orthopaedic surgeons should focus on how to assist our patients — and team with them as a caring health professional — in their efforts to stop smoking and stay smoke free.
- For more information:
- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Road, Thorofare, NJ 08086 USA; email: orthopaedics@healio.com.