Kick the Habit Before Brain Surgery

Smoking before brain or spine surgery restricted essential blood flow

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Any time is a great time to quit smoking. But quitting before having brain or spine surgery might be essential to a successful surgery and a healthy recovery.

In a recent review, researchers looked at patients who had undergone brain or spine surgery and their smoking habits.

The results of the study showed that non-smokers and former smokers had fewer surgical complications, better healing and lower risk of death compared to smokers.

"Quit smoking before surgery."

Darryl Lau, MD, from the Department of Neurological Surgery at the University of California San Francisco, led an investigation into brain and spine surgical complications in smokers.

According to the study authors, even low levels of tobacco smoke have been shown to be detrimental to overall health and are associated with cancer, heart disease, stroke and birth defects.

"One in five deaths in the US is attributed to tobacco use, which translates to nearly half a million deaths annually," the authors wrote.

For this study, the researchers looked through published medical studies between 1950 and 2012 dealing with "smoking and neurosurgery" or "tobacco and neurosurgery."

Previous research has shown that smoking can generate toxic effects in the body, including cell damage, reduced immune function and lack of oxygen circulation throughout blood vessels and tissue in the body.

Several studies that the authors identified for their review contained supportive evidence that smoking was associated with the risk for developing an aneurysm and having an aneurysm rupture.

An aneurysm is a bulging pocket filled with blood attached to the wall of a blood vessel. This pocket can burst in the brain and increase the risk of death.  

Smokers inhale high levels of carbon monoxide, which can build to toxic levels in the blood stream. Smokers also inhale nicotine, which reacts with the body’s adrenal system and metabolism. Both carbon monoxide and nicotine travel through the blood stream of smokers and get in the way of proper blood flow to the small blood vessels and tissues in the body.

The body relies on blood to deliver essential nutrients, oxygen and immune cells to wound sites and to help fight off infections.

Due to the presence of toxic chemicals in the blood stream and reduced circulation, smokers in this review were shown to have higher risk for poor wound healing and infection.

"In addition to the problems that smoking can cause during surgery for a patient, it can also be responsible for major complications after surgery," said Dr. Neel Anand, Director of Spine Trauma at the Cedars-Sinai Spine Center.

Greater blood loss during brain and spine surgeries was also found among smokers in two of the studies in the review.  

The researchers found that in one study with 453 brain tumor removal patients and another with 500 spine surgery patients, smokers had a greater risk of blood loss during surgery, as well as surgical complications. The spine surgery patients who were smokers had higher rates of blood transfusion during surgery and delayed healing after surgery.

"By way of what it does to our whole body, smoking weakens the immune system. After surgery is when we want our immune system to be in its best working order because it helps us fight off infection and recover more quickly and completely. When immune systems are compromised, we surgeons see many more infections and healing times that are increased far longer than they should be," said Dr. Anand. 

The researchers found that patients who quit smoking four to eight weeks before surgery had better surgical outcomes and fewer surgical complications than patients who continued to smoke.

The authors concluded that healthcare providers should encourage patients who are about to undergo neurosurgery to quit smoking in order to reduce the chances of complications, delayed healing and possible death.

This study was published in June in the Journal of Neurosurgery.

No outside funding sources were used for this study. No conflicts of interest were declared.

Reviewed by: 
Review Date: 
June 18, 2013
Last Updated:
August 2, 2013