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Clinical Challenges
June 2009

Preoperative Smoking Cessation: Impact on Perioperative and Long-term Complications

Author Affiliations

J. PIETERNOORDZIJMDAuthor Affiliation:Department of Otolaryngology–Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts.

Arch Otolaryngol Head Neck Surg. 2009;135(6):597-601. doi:10.1001/archoto.2009.33

Hypothesis:Smoking cessation at the time of diagnosis with an upper aerodigestive tract squamous cell carcinoma minimizes perioperative morbidity and improves long-term outcome.

Habitual tobacco use is the leading preventable cause of death in the United States and is responsible for 1 of every 5 deaths.1Although there has been a steady decline in the percentage of smokers since 1960, a plateau in this progress has been noted in the past decade. In 2000, 25.7% of males and 21.0% of females were smokers.2The physiologic impact of smoking is well described and includes impaired mucus transport and pulmonary macrophage function, increased bronchial reactivity and arterial carbon monoxide levels, reduced oxygen transport, and inhibited mitochondrial oxidative metabolism.3In addition, active smoking, including heavy (≥20 cigarettes/d) and lighter users, has also been associated with an increased relative risk (1.44 overall) of the future development of type 2 diabetes mellitus.4