Why do I have to stop smoking just to get surgery?

As a prescribing psychologist, I've been to medical school and graduate school so I know the dangers of smoking before surgery. But I can also see how someone without medical training might think as one patient said to me a week ago, "What's the big deal? I know surgery can be dangerous but why do I have to quit smoking to get it? After all, surgery only lasts a couple of hours, can't I just quit the day before?"

Here's why the big deal... Did you know that smoking can place the success of your surgery at risk? 

How smoking can mess with your surgery

1. Healing: Smoking affects your body’s ability to heal and recover after surgery. Nicotine and other harmful chemicals in cigarettes constrict blood vessels, which can lead to reduced blood flow and oxygen delivery to the surgical site. This can delay the healing process and increase the risk of infection. Pretend you're trying to wash a gash on your hand. You're hand is bleeding because you were planting a garden and mistakenly punched a hole in the palm of your hand. You go to the sink with blood and dirt on your hand but when you turn the water on, just a trickle of water comes out. The pipes are clogged with gook and crud so the water can't get through. Minimal water means minimal flow to the injury. Now picture your smoking as creating a clog or narrowing in your blood vessels such that the healing oxygen can't get to the wound like it does for non-smokers. Since bariatric surgery involves cutting and stapling the intestines, the reduced blood flow can result in infections because oxygen is the primary source of wound healing.

2. Blood Clots: Let's stick with the bathroom pipes metaphor because another concern is that smoking can increase the likelihood of developing blood clots. After bariatric surgery, smokers are at a higher risk of developing blood clots due to the changes in blood flow and the length of the procedure. Smoking further increases this risk by thickening the blood and reducing the body’s ability to break down clots. So imagine now that instead of nice clear water struggling through the pipes, your smoker's pipes have a mud water consistency. Instead of a clear flexible flow, you have more of a sludge trying to pass through the pipes. Are you picturing things getting backed up and occasionally stuck? Because that's what can happen to your blood during and after surgery.

3. Pulmonary Complications: You probably could have guessed this one on your own. After any surgery, you may experience breathing issues. If you are a smoker, you likely already have damaged lungs, making it difficult to get enough oxygen needed for healing. This can decrease your lungs’ ability to fight off infections, leaving you vulnerable to develop pneumonia or other respiratory complications after surgery.

4. Marginal Ulcers: Ulcers are already common in smoking adults, but after bariatric surgery, the risk of developing an ulcer significantly increases. In a healthy adult, ulcers heal naturally by pumping blood to the stomach. After the surgery, however, the smaller stomach limits blood flow to the stomach and affects the ability of ulcers to heal.

In general, smokers after bariatric surgery have a 30% increased risk of complications. Long-term smoking can even decrease your ability to lose weight and increase the risk of future complications, such as ulcers at the site of surgery.

​You risk surgery postponement or cancellation if you smoke within four weeks prior to your procedure. Some surgeons will not risk performing the surgery AT ALL due to the complications and difficult healing process brought upon by smoking.

Why you should quit before surgery

There are many reasons why quitting smoking before bariatric surgery is crucial. But probably the most obvious is that most of you have made the decision to lose weight with surgery to improve your health and life span. So why would you put yourself at risk for surgical complications and an early death by continuing to smoke? 

I can hear many of you now, "Don't you think I've tried!??! Do you think I like smoking when I know it causes emphysema, lung cancer, wrinkled skin and all the many problems I hear from doctors ALL THE time?"

Well, I have a bit of positive news for you. According to the American Red Cross, it takes a smoker, on average, 7 attempts to quit before they quit for good. So, I'm including resources here to help get you to #7.

Resources for Quitting Smoking

1. The New Mexico Quitline: The Quitline is a free, confidential service that provides support and resources to help smokers quit. They offer coaching over the phone, online support, and nicotine replacement therapy.

2. The American Lung Association (Quit Assist): The American Lung Association has a variety of resources to help smokers quit, including online support, quit smoking guides, and a Lung HelpLine.

3. Smokefree.gov: Smokefree.gov is a website that offers free resources to help smokers quit. They have online tools and resources, as well as a text messaging program that provides support and encouragement.

4. Nicotine Anonymous Online: Nicotine Anonymous is a support group for people who want to quit smoking. They also have in-person meetings in many cities across the United States and offer a 12-step program to help smokers quit.

Medicines to help you quit smoking

There are several medications available that can help you quit smoking, including:

1. Nicotine replacement therapy: This includes nicotine patches, gum, lozenges, and inhalers that contain controlled doses of nicotine. They can help reduce nicotine cravings and withdrawal symptoms.
2. Bupropion: This is a prescription antidepressant that can also help reduce nicotine cravings and withdrawal symptoms.
3. Varenicline: This is a prescription medication that can reduce the pleasure you get from smoking and help reduce nicotine cravings and withdrawal symptoms.

Phone Apps to help you stop smoking

1. Quit Genius: This app offers personalized coaching and a cognitive behavioral therapy program to help you quit smoking.
2. Smoke Free: This app tracks your progress, provides motivational messages, and offers tips to help you quit smoking.
3. Quit Smoking Slowly: This app provides a 90-day quit smoking plan that helps you gradually reduce your tobacco intake until you can quit completely.

Remember, quitting smoking can be difficult, but it is possible. Combining online support with an app and maybe medication, can increase your chances of success. Remember to check with your bariatric surgeon for limitations with regard to medicines you can take before and after surgery.

Everyone is different so don't be afraid to make mistakes, just keep reminding yourself that your striving for not only a longer life, but one with better quality where you can run, ride a bike, take hikes, play with your kids or grandkids without getting winde. And if you need a little more motivation, how about some images?