Short‐term pre‐operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial

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Abstract
Background Smokers have a higher risk of complicated tissue and wound healing after surgery than nonsmokers. We tested the hypothesis that short‐term pre‐operative cessation of smoking in colorectal surgery decreases the incidence of postoperative tissue and wound complications. Methods From February 1998 to March 2001, 60 patients, who smoked daily, undergoing colorectal resection were randomly assigned 2–3 weeks before scheduled surgery to either abstinence from smoking, counselling and nicotine replacement therapy or maintenance of daily smoking habits. Postoperative tissue and wound complications necessitating surgical or medical treatment were evaluated at discharge and 30 days after surgery by blinded outcome assessment. Results In the pre‐operative period of 15 days (8–24) (median, interquartile range (IQR)), 89% of the patients in the intervention group vs. 13% in the control group abstained from smoking or reduced by more than half (P < 0.05). In the postoperative period of 11 days (10–13), the corresponding figures were 92% and 50%, respectively (P < 0.05). Postoperative tissue and wound complications occurred in 33% (9 of 27) of the patients in the intervention group compared to 27% (8 of 30) in the control group (NS). Likewise, no difference in overall postoperative complication rate was found between the groups. Conclusion Short‐term cessation of smoking does not reduce the risk of complicated tissue and wound healing or other complications in colorectal surgery.