A 60-year-old man who smokes 20 cigarettes daily is scheduled for elective total knee replacement in five weeks. He asks whether quitting now will worsen his outcome because of increased sputum. Which counsel is correct?
- A He should continue smoking until after eight weeks postoperatively
- B He should quit immediately; there is no evidence that recent cessation increases pulmonary risk ✓
- C He should reduce to five cigarettes daily instead of stopping
- D He should quit only after completing preoperative physiotherapy
Correct answer: B. He should quit immediately; there is no evidence that recent cessation increases pulmonary risk
Explanation
The old teaching that cessation less than eight weeks before surgery raises complication rates has been refuted; meta-analyses show reduced pulmonary and wound complications even with brief preoperative abstinence. Within days, carboxyhaemoglobin falls and the oxyhaemoglobin dissociation curve normalises, improving oxygen delivery, while ciliary and macrophage function begin recovering over weeks. Harm reduction by cutting down does not achieve these effects. Every smoke-free day confers measurable benefit before the operation date.
Reference: Miller's Anesthesia, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.