How does smoking cessation impact perioperative outcomes and recommended duration of abstinence?

• A. Reduces pulmonary complications and wound healing impairment; ideally quit 4–8 weeks before elective surgery if feasible
• B. No impact; quit never
• C. Worsens wound healing; continue smoking
• D. Only affects anesthesia duration

Answer: (A)

Smoking adds perioperative risk by causing respiratory problems and slowing wound healing. Nicotine constricts blood vessels, reducing tissue perfusion, while carbon monoxide lowers the blood’s oxygen-carrying capacity. Smoking also impairs mucociliary clearance and immune function, increasing the chances of atelectasis, pneumonia, bronchospasm, wound infection, and slower wound healing. When a patient stops smoking before surgery, these risks begin to decline, and the longer the abstinence, the greater the benefit—especially for the lungs and healing tissues. Recommending abstinence for about 4–8 weeks before elective surgery captures the window where pulmonary complications and healing impairment are meaningfully reduced, balancing feasibility with measurable benefits. Benefits can start within days of quitting, but the 4–8 week target is a practical, evidence-informed period to maximize perioperative outcomes. The other statements ignore the established impact of smoking on perioperative risk, or mischaracterize its effects, such as suggesting no impact or that quitting has no benefit.