Smoking linked to higher risk of surgery complications (2025)

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Smokers and people who recently quit are more likely to face complications after having an operation than non-smokers, a new study reveals.

Experts say there is an urgent need for focussed action to encourage people to stop smoking before undergoing elective surgery, after the pan-European research revealed that 19.5% of elective surgery patients are current smokers.

Backed by National Institute for Health and Care Research (NIHR) funding, researchers discovered higher smoking rates among younger patients (18-40 years: 26.8%) and male patients (22.1%). Healthy adults without long-term conditions also exhibited higher smoking rates (24.6%).

Publishing their findings in The Lancet Regional Health - Europe, researchers at the University of Birmingham, working with the STARSurg Collaborative, reveal that current smokers and recent ex-smokers (those quitting within six weeks to one year before surgery) face higher odds of postoperative complications compared to patients who had never smoked.

Our findings highlight the high prevalence of smoking among elective surgical patients, particularly among younger and healthier individuals. Since we know that these patients are more likely than non-smokers to experience postoperative complications requiring extra bed days, the potential cost to the NHS is huge."

Dr. Sivesh Kamarajah, Lead Author, University of Birmingham

"This presents a unique opportunity for healthcare providers to put in place effective smoking cessation strategies, improving both short-term surgical outcomes and long-term health. Embedding strong programmes to help people quit smoking into elective surgical systems may lead to more efficient, preventive care across the entire health system.

Researchers analyzed data from 16,327 patients across 442 hospitals in 29 European countries. The study was conducted as part of the CASCADE cohort study, involving a comprehensive analysis of smoking status and its impact on postoperative complications among patients undergoing elective abdominal surgery.

"We found high complication rates up to a year after quitting smoking, which is surprising and challenges current convention, added Dr Kamarajah. "Poor short-term outcomes amongst current smoker exposes the urgent need to strengthen smoking cessation pathways for planned elective surgical care, where waiting times may be up to three to six months before surgery."

Tobacco smoking remains a leading risk factor globally, contributing to over 10% of alldeaths and nearly 142 million years of life lost annually. Despite concerted public healthmeasures, Europe retains the highest regional smoking prevalence, with 36% of men and20% of women actively smoking.

Within healthcare, elective activities in secondary care, including planned surgery, represent a critical but underleveraged setting for preventive interventions such as smoking cessation. Existing guidelines recommend smoking cessation up to six weeks before surgery to reduce risk of complications; however, this guidance is largely based on studies conducted over a decade ago.

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