Smoking before surgery can increase your risk of post-operative complications and slow the healing process.

If you’re a smoker, it’s understandable if you feel like reaching for a cigarette before surgery. However, doing so can interfere with the outcome of your procedure.

The World Health Organization (WHO) recommends that you avoid smoking for at least 4 weeks prior to surgery, while the American Society of Anesthesiologists advises that you quit for at least a week before anesthesia.

That said, 2019 research suggests that the longer you go without smoking beforehand, the lower your chance of surgery-related risks.

Here’s what else to know about avoiding smoking before surgery.

There are more than 4,500 chemicals in cigarette smoke, most of which have negative impacts on your health. When you’re about to undergo surgery, these negative effects can have a greater impact due to your more vulnerable state.

Smoking prior to surgery is associated with an increased risk of:

  • Longer stays and emergencies: According to a 2019 review, smoking is associated with higher rates of intensive care unit admissions, emergency readmissions, and longer inpatient stays after the procedure.
  • Infections and complications: Smoking impacts your immune system, which can make it harder for your body to heal after surgery. According to the Centers for Disease Control and Prevention (CDC), smoking raises your risk of infections and other complications.
  • Perioperative morbidity and mortality: The previously mentioned 2019 review found that smoking boosts the risk of perioperative morbidity and mortality or death that may occur within 30 days after surgery. The more someone smokes, the greater their health risks.

More specifically, smoking before surgery can cause issues with your:

  • Respiratory system and lungs: Smoking impairs the function of the heart and lungs. During and after surgery, this impairment can cause breathing problems. It can also increase the risk of pneumonia, lung collapse, or the need for a ventilator after the procedure.
  • Cardiovascular system: Nicotine, carbon monoxide, and other toxins found in cigarette smoke may raise the risk of heart complications during or after surgery, including heart attack and stroke.
  • Joints, muscles, and bones: Smoking can negatively impact your bones’ ability to heal. If you’re getting orthopedic surgery or another procedure for a musculoskeletal injury, your recovery may take longer.
  • Skin’s healing mechanism: The nicotine, carbon monoxide, hydrogen cyanide, and other toxins in cigarettes negatively impact wound healing, which can delay recovery and increase the risk of scarring.
  • Responsiveness to anesthesia: Though anesthesia always has some risk of complications, smoking increases this risk. In particular, smoking before receiving an anesthetic can contribute to respiratory issues, slower recovery time, and the need to use more anesthetics.

The sooner you can stop, the better. Quitting smoking at least 4 weeks before surgery is linked to better outcomes, according to a 2020 WHO report.

Talk with a care team for a more specific timeframe in which to quit smoking ahead of your surgery.

Smoking after surgery can impact your body’s ability to carry out vital processes needed to heal after your operation.

Smoking postsurgery may:

  • reduce blood flow
  • raise your risk of heart problems, including heart attack
  • heighten your risk of infection
  • increase the risk of complications, including coma or death

The American College of Surgeons advises people to not smoke for about 4 weeks after having surgery. Again, talk with a care team that can provide a more specific timeframe.

First, don’t panic. You’re not alone. According to 2019 data collected on more than 300,000 people in Michigan, as many as 1 in 4 smokers still smoked cigarettes at the time of surgery.

If you’ve smoked within 24 to 48 hours before surgery, the best thing you can do is to talk with a doctor. You should also try to avoid having another cigarette beforehand.

Since smoking tobacco even a few hours before the procedure can come with additional risks, avoiding further cigarettes may still have a positive impact. Even stopping 1 day before your procedure can reduce your risk of complications.

Depending on your situation, a doctor may recommend rescheduling the procedure. If the surgery isn’t urgent, a new appointment may be recommended.

In some cases, a doctor may also perform a cotinine test to test for the presence of cotinine, the primary metabolite of nicotine, in your urine. People often call this a “nicotine test.” If nicotine has been detected, the risk to the tissues being operated on may be high enough to consider rescheduling.

Your health is the most important consideration for both you and the doctor, so don’t hesitate to bring up any concerns you have.

In the United States, more than 3 out of 5 adults who have ever smoked have quit.

What works for one person won’t always work for another, but here are some tips that may help kick-start your journey:

  • Go cold turkey: According to research from 2016, quitting abruptly may be an effective long-term solution. In the study, those who quit abruptly had a 49% quitting success rate at 4 weeks compared with 39% who quit gradually. Both groups also had counseling support and underwent nicotine replacement therapy.
  • Nicotine replacement and other medicated therapies: Patches and other forms of nicotine replacement therapy can make the physiological transition much more bearable. The drugs varenicline and bupropion, for example, can be effective.
  • Counseling: A counselor trained in addiction can help you build the tools and coping mechanisms necessary to quit smoking for good. To get started, try calling 1-800-QUIT-NOW or checking out
  • Alternative therapies: Some people find success with alternative therapies such as hypnosis, acupuncture, and meditation. Starting new activities can also help. These therapies can also be used in combination with any of the above methods.

Learn more about all the ways to quit smoking.

Smoking before surgery comes with a heightened risk of complications, including lung and heart problems, slower wound healing, and even coma or death.

Most experts recommend that you quit smoking for as long as possible before surgery or for at least 4 weeks. After surgery, experts recommend that you avoid smoking for at least another month.

If you need assistance abstaining from smoking during this time period, talk with a doctor. There are plenty of counseling, nicotine replacement therapies, and other resources available to help you.