Surgeons urge patients to stop tobacco, e-cigarette, and marijuana use to reduce surgery risks
CHICAGO: More than a dozen states1 now allow recreational marijuana use, and millions of adults use e-cigarettes regularly2, but surgeons warn that even as these products become more widely available, they can be harmful if used before an operation. At panel discussions during the virtual American College of Surgeons (ACS) Clinical Congress 2020, experts underscored the importance of helping patients stop tobacco, vaping, and marijuana use before having an operation.
"If you are inhaling anything at all, it increases the risk of respiratory complications," said Thomas K. Varghese, Jr., MD, MS, FACS, thoracic surgeon, University of Utah, Salt Lake City, and director of the ACS Strong for Surgery program, which focuses on strategies to help patients improve their health and reduce risk factors in preparation for an operation.
"Studies show smoking and vaping before an elective operation doubles the risk of postoperative pneumonia and increases the risk of a heart attack by 70 percent," said Jonah Stulberg, MD, PhD, MPH, FACS, general surgeon and health services researcher at Northwestern Memorial Hospital, Chicago.
"Smoking remains a large public health problem," Dr. Stulberg said. "Evidence shows all patients should quit before their procedure."
Even in the case of routine procedures, stop-smoking programs can reduce the risk of complications, experts said. For example, a 2018 analysis of patients undergoing elective hernia repair found that non-smokers had a significantly lower risk of complications than smokers.
John M. Daly, MD, FACS, FRCSI (Hon), FRCSG (Hon), interim dean, Lewis Katz School of Medicine at Temple University, Philadelphia, outlined data showing 10 percent of the general population uses marijuana, including 43 percent of cancer patients. He also cited a study of trauma patients in Colorado that showed 21 percent of trauma patients reported using marijuana, and among users, 30 percent say they are chronic users. "More patients are using marijuana, so surgeons need to understand how to manage patients who chronically use it, and patients need to understand the potential risks and benefits of its use," he said.
Deciding to quit smoking before an operation can have lasting effects, the surgeons said. A variety of studies show long-term quit rates are higher in patients who quit in anticipation of an operation. One study found that 15 percent of smokers who participated in a quit-smoking program before surgery quit by the day of their operation, compared to four percent in the control group. One month later, 28 percent had stopped smoking, and after a year, a quarter continued to avoid smoking.4 While patients should ideally quit smoking as far as possible before an operation, experts said, quitting any amount of time before surgery is more beneficial than not quitting.
"The time before an operation is a great time to empower patients to take action, improve their health, and reduce their risks," said John DeLancey, MD, MPH, urologist, The Ohio State University Wexner Medical Center, Columbus.
Malcolm DeCamp, MD, FACS, chair, division of cardiothoracic surgery and professor of surgery and medicine, University of Wisconsin School of Medicine and Public Health, Madison, agrees. "Two to three weeks of sustained effort - getting the cigarettes out of your life - helps deal with the physical part of the addiction," said Dr. DeCamp. "Then you have the operation and the immediate recovery where we can reinforce that and work on the psychological aspects."
To support patients who want to quit smoking, the ACS Strong for Surgery and Surgical Patient Education programs have created toolkits and resources for patients, surgeons, and hospitals. The goal is to help more surgeons intervene before an operation. Currently, more than 330 hospitals around the country participate in the Strong for Surgeon program. As vaping and marijuana use becomes more widespread, these tools can help surgeons educate their patients on the potential harmful effects.
"The biggest motivation a patient has is that they want their operation to go well," said Dr. Varghese. "Many patients will do whatever is needed to make sure their surgery is a success. Surgeons can provide their patients with resources to be able to stop smoking and help create the environment that leads to success."
"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.
Citation: When and How to Quit Cigarettes, Vaping, and Marijuana Use Prior to Surgery, panel session, American College of Surgeons Clinical Congress 2020, October 6, 2020. The Impact of Marijuana Use in the Surgical Patient, panel session, American College of Surgeons Clinical Congress 2020, October 5, 2020.
1 "State Medical Marijuana Laws." National Conference of State Legislatures. March 10, 2020. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx (.)
2 Dai H et al. Prevalence of e-cigarette Use Among Adults in the United States, 2014-2018. JAMA. 2019;322(18):1824-1827.doi:10.1001/jama.2019.15331 (.)
3 DeLancey et al. The effect of smoking on 30-day outcomes in elective hernia repair. Am J Surg. 2018 Sep;216(3):471-474. doi:doi:10.1016/j.amjsurg.2018.03.004 (.)
4 Lee et al. Long-term quit rates after a perioperative smoking cessation randomized controlled trial.
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