50+ Lifestyles

Make Your Surgery Safe

By Joseph L. Lohmuller, MD, MS, FACS
Davenport Surgical Group P.C.

Surgery involves the risk of complications. Anything that can be done to make a surgery safer is worth an effort…

The patient in my office was a little surprised when I told him I would strongly recommend he stop smoking before we considered proceeding with his elective operation. We reviewed data on smoking-related increased risks of infection (36% in hernia operations), hospital readmission (24% increase in hernia repairs) and death within 30 days – rare in hernia operations to begin with (53% increase in smokers).

Based on the hernia he needed surgery for I also suggested we use an approach that does not require a general anesthetic. General anesthetics increase the chance of pneumonia and other lung complications in smokers, hernia recurrence due to severe coughing afterward, and heart stress which comes with the anesthesia drugs anyway. Stopping smoking for as little as four weeks prior to surgery can eliminate or lower these risks substantially in many cases.

One area of our specialty involves breast cancer surgery. Smoking increases the risk of many cancers including breast cancer and it also increases the chance of infection after all types of breast surgery for cancer. In cases when a mastectomy is needed the chance of smoking-related infection is particularly high. Most plastic surgeons will not consider breast reconstruction after mastectomy in smokers because of the high complication rates of infection.

I once attended a symposium where the head of the esophageal cancer program at a major university medical center related that he will not perform surgery to remove esophageal cancers in smokers unless they quit. He measures nicotine byproducts in the urine of his patients to make sure they have done so. He found the complication rates so high in smokers that he felt it was unconscionable to do the surgery even though the patients die without it.

Surgery involves the risk of complications. Anything that can be done to make a surgery safer is worth an effort, even if it means breaking a long time habit like cigarette smoking. Saves money, too.