Thank you for not smoking

8 January 2007
Patients who refuse to quit smoking before elective surgery should be refused treatment in certain circumstances, a University of Sydney academic and practising surgeon argues.

When everything else is equal, "costs are increased and outcomes are worse in a smoker than in a current non-smoker", said Clinical Associate Professor Matthew Peters.

"In healthcare systems with finite resources, preferring non-smokers over smokers for a limited number of procedures will deliver greater clinical benefit to individuals and the community - smokers and non-smokers.

"To fail to implement such a clinical practice in these select circumstances would be to sacrifice sensible clinical judgment for the sake of a non-discriminatory principle."

Smoking up until any surgery increases cardiac and pulmonary complications, impairs tissue healing, and is associated with more infections and other complications said A/Professor Peters.

He writes that "as long as everything is done to help patients to stop smoking, it is both responsible and ethical to implement a policy that those unwilling or unable to stop should have low priority for, or be excluded from, certain elective surgical procedures."

Such an approach should be limited to procedures where "evidence of harm is strongest", including plastic and reconstructive surgery and some orthopaedic surgery.

He acknowledges that "smoking is rarely the only risk factor for a poor outcome and smoking should not be considered to the exclusion of all others". But A/Professor Peters writes that it is "unique in that its associated risk can be reduced substantially within a short period".

The full text article "Should smokers be refulsed surgery?" is featured on the BMJ website.

Contact: Kath Kenny
Phone: 02 9351 2261 or 0434 606 100