Smokers urged to quit or risk being denied surgery

A growing number of hospitals in Finland are asking smokers to quit before they come in for scheduled surgery. Smokers face greater risks during surgery and treatment outcomes are poorer than for non-smokers. In some cases, medical personnel are turning away smokers who book elective surgery.

 

Finnish hospitals want their patients to be smoke-free for up to eight weeks before scheduled surgery.

For example, orthopedic surgery patients who are smokers are at much higher risk for post-operative wound infections than non-smokers.

The need for repeat surgery is also greater among smokers, as are heart and chest complications.

“In some cases, the risk of inadequate bone tissue formation grows by up to 16 times,” says Doctor Antti Kyrö, of Päijät-häme Central Hospital.

Smokers also have longer recovery times, require more follow-up visits to the polyclinic and may need longer sick leaves.

According to Kyrö, who says he believes the criteria for getting smokers onto the operating table will be tightened in Finland, the University Hospital of Umeå in Sweden has already implemented tight criteria for smokers potentially heading to surgery.

“As far as I know, they have decided that non-urgent orthopedic operations will not be performed if a patient smokes,” says Kyrö.

In addition to health benefits, if a patient stops smoking up to eight weeks before surgery the savings to a hospital or municipality can be significant.

For example, a deeply infected surgical wound can end up costing 20,000 euros and the subsequent sick leave up to 48,000 euros or more.

“The cost can even run up to 100,000 euros,” says Senior Physician Outi Nyberg of Länsi-Pohja’s Central Hospital. “But it (a seriously infected surgical wound) always means additional costs compared to an operation that goes well,” she says.

Eight weeks smoke-free before surgery

At Länsi-Pohja hospital, it’s now standard procedure that orthopedic surgeons don’t perform surgery on a torn Achilles tendon if the patient smokes.

“It’s cared for by cast or a support,” says Nyberg.

In Kemi, several hospitals are adopting the model of helping patients butt out well in advance of surgery.

“Patients are encouraged to start a smoking cessation programme when they are put into the queue for surgery. The goal is to quit smoking eight weeks before surgery,” says Kyrö.

According to Nyberg, the most important issue is that the patient understands how smoking increases risks during surgery.

Yle Finland