If you're a smoker considering foot or ankle surgery, it's crucial to understand the impact smoking can have on your recovery. Cigarette smoke contains harmful chemicals, including nicotine, hydrogen cyanide, and carbon monoxide, which can significantly hinder healing. Smoking increases the risk of poor bone and tissue healing, infection, and postoperative pain.
Reduced Oxygen Levels
Oxygen is essential for healing after surgery. However, the chemicals in cigarette smoke interfere with how the body processes oxygen. Hemoglobin, the molecule responsible for carrying oxygen throughout the body, is less effective when exposed to cigarette smoke. Additionally, smoking causes tiny blood vessels to narrow, making it difficult for oxygen to reach the areas that need it most.
Impaired Blood Flow
Smoking thickens the blood, making it harder for it to flow through narrowed blood vessels. This can be likened to reducing a busy four-lane highway to two lanes and covering it with sticky tar, making it much harder for traffic to move. Similarly, oxygen cannot reach the surgical site efficiently, complicating the healing process.
Delayed Bone Healing
Smoking can prevent the bones in your foot or ankle from healing properly, a condition known as nonunion. Research indicates that smokers face a 2-10 times higher risk of wound complications and nonunion after surgery compared to non-smokers.
Increased Risk of Infection
Smoking impairs the body's ability to fight infections post-surgery. Chemicals in cigarette smoke reduce the activity of neutrophils, the body's infection-fighting cells. Without fully functional neutrophils, the risk of infection increases, potentially necessitating antibiotics or additional surgery. Smokers are up to four times more likely to develop an infection after foot surgery than non-smokers.
Enhanced Postoperative Pain
Studies show that smokers may experience more postoperative pain than non-smokers. Chemicals in cigarette smoke can increase inflammation and affect pain perception, leading to heightened and prolonged pain after surgery.
Are These Effects Permanent?
The positive news is that quitting smoking before surgery can reduce these risks. Even a short-term cessation of 4-6 weeks before and after surgery can significantly lower the chance of complications. For urgent surgeries, such as those for an ankle fracture, smokers who quit immediately post-surgery have fewer complications than those who continue to smoke.
How Can I Quit Smoking?
Quitting smoking is challenging, but numerous resources are available to help. You can call 1-800-QUIT-NOW or visit smokefree.gov for online support and to create a quit plan. For those outside the United States, local resources or your primary care doctor can offer assistance. Working with a counselor can triple your chances of successfully quitting compared to attempting to quit cold turkey. Dr. Kamel, in collaboration with your primary care physician, may also recommend medications to aid in quitting.
While smoking increases the risk of complications after surgery, it is a modifiable risk factor. By quitting smoking and utilizing available resources, you can greatly improve your chances of a successful recovery after foot or ankle surgery. Talk to Dr. Kamel and take the first steps toward quitting smoking for better surgical outcomes.