Does Secondhand Smoke Contribute To Delayed Post-Op Healing?

By Brian McCurdy, Senior Editor

Doctors in various professions have noted the deleterious effects of smoking on post-op healing. A new study says smokers take almost twice as long to heal as nonsmokers and also sheds light on another aspect of smoking: the delayed effects of healing in those exposed to secondhand smoke.    Conducted at the Oakwood Hospital System in Michigan, the study, presented as a poster at the American College of Foot and Ankle Surgeons Annual Scientific Meeting, tracked 46 patients who had undergone Austin bunionectomies. The group was comprised of 17 smokers, 17 nonsmokers and 12 people exposed to secondhand smoke.    The patients underwent a modified Fagerstrom test for nicotine dependency and also underwent urine tests to measure nicotine levels, according to the study. Authors say the average time of post-op healing was 69 days in non-smokers, 78 days in people exposed to secondhand smoke and 120 days in smokers.    “Our study results were not a surprise except for the effects of secondhand smoke,” notes study co-author Lawrence Fallat, DPM, a Clinical Assistant Professor within the Department of Family Medicine at the Wayne State University School of Medicine in Detroit. “There are many studies in the orthopedic literature that indicate delayed healing and nonunion are much higher in smokers. The surprise is that secondhand smoke also delays bone healing just as if the patients were primary smokers.”

Keys To Patient Education

How can one best communicate to patients the effects of smoking on postoperative healing? When patients with fractures seek elective bone surgery, Dr. Fallat explains to them that if they smoke, they will take longer to heal and may experience nonunions.    Peter Wilusz, DPM, explains to patients that smoking has an adverse effect on healing as carbon monoxide binds to red blood cells so oxygen cannot bind and reach the tissues, making it difficult for tissues to heal.    “Taking a little extra time to explain the details of postoperative complications (wound dehiscence, infection, amputation, etc.) associated with smoking may open the eyes of a few reasonable patients,” says Dr. Wilusz, a Diplomate of the American College of Foot and Ankle Surgeons.    Furthermore, if the procedure is elective, Dr. Wilusz advises telling patients that they must quit smoking 10 weeks before surgery and also advises DPMs to measure pre-op nicotine levels prior to proceeding with surgery.

What About Future Directions For Research?

Where is further research headed? Dr. Fallat is currently conducting a retrospective study on the effects of smoking on the diabetic foot. He notes that he expects to discover a higher incidence of ulcers and amputations in diabetic smokers due to the vasoconstrictive effects of nicotine.    Dr. Wilusz says research has shown that patients with diabetes who smoke have a risk of cardiovascular complications that is 40 times greater than that of nonsmoking patients with diabetes. He notes one can likewise expect more post-op complications in diabetic smokers. Dr. Wilusz does not perform elective procedures on patients with diabetes who smoke.    “I feel there needs to be evidence-based research showing definitive facts that the risk of elective surgery outweighs the benefit of proceeding with surgery in the diabetic smoking population,” maintains Dr. Wilusz. “We as physicians need to take on a greater responsibility to recognize, educate and intervene on behalf of this group of individuals.”

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