What is considered the most important postoperative complication in patients who smoke?

• A. Delayed wound healing due to impaired oxygenation
• B. Excessive scarring
• C. Hyperglycemia
• D. High pain tolerance

Answer: (A)

Smoking reduces tissue oxygenation and blood flow, which directly impacts wound healing after surgery. Carbon monoxide from smoke binds to hemoglobin with high affinity, lowering the amount of oxygen delivered to tissues. Nicotine causes vasoconstriction, further reducing blood flow to the surgical site. Because oxygen is crucial for collagen synthesis, fibroblast activity, and immune function, these factors slow healing, raise infection risk, and increase the chances of wound dehiscence. That makes delayed wound healing due to impaired oxygenation the most significant postoperative issue in patients who smoke. Excessive scarring, hyperglycemia, or high pain tolerance are not as directly tied to the immediate postoperative risks associated with smoking.