A 55-year-old man who smokes 20 cigarettes daily is posted for elective open inguinal hernia repair in four weeks. He asks whether he should quit now or closer to the operation. What is the MOST appropriate advice?
- A Continue smoking until one week before surgery to minimise withdrawal stress
- B Delay quitting, because stopping less than eight weeks before surgery increases complication rates
- C Stop immediately, because abstinence of eight weeks or more clearly reduces pulmonary complications ✓
- D Smoking status has no measurable effect on perioperative outcomes
Correct answer: C. Stop immediately, because abstinence of eight weeks or more clearly reduces pulmonary complications
Explanation
Current evidence shows that longer preoperative abstinence progressively lowers pulmonary, wound and infectious complications, with clear benefit at eight weeks or more. The older belief that recent cessation raises complication rates has been disproven, so there is no reason to postpone quitting. Even short abstinence helps: carboxyhaemoglobin falls within days, improving oxygen delivery, and nicotine-related coronary vasoconstriction resolves quickly. Advice should therefore be to stop at once, supported by counselling or pharmacotherapy.
Reference: Miller's Anesthesia, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.