Policy number: SRP 001
Policy name: Smoking / Weight Management and Surgery
Status: Overarching commissioning policy
Effective date: 1 April 2024
Next review date: 1 April 2026
Smoking and Surgery
All patients being referred for non-urgent elective surgery who are smokers should be referred to smoking cessation services by the GP at the time of referral, and strongly encouraged to be non-smokers at the time of surgery.
There is strong evidence of higher risks and worse surgical outcomes when a patient continues to smoke. The risks associated with smoking mean that it is not always safe for surgery to take place when a patient continues to smoke and, as a result, some surgeons will not carry out procedures until a patient is able to abstain from smoking.
For smokers who are unable to quit, the Royal College of Anaesthetists advises that smokers should give up smoking for at least several weeks before surgery and certainly not to smoke on the day of an operation. Smokers are 38% more likely to die after surgery than non-smokers.
Joint briefing: Smoking and surgery
Obesity and Surgery
There is strong clinical evidence that obese patients undergoing surgery are at significantly higher risk of getting infections and suffering heart, kidney and lung problems than people who are a healthy weight. They are also likely to have to spend more time in hospital recovering and their risk of dying as a result of surgery is higher compared to patients with a normal weight.
Overweight patients are strongly encouraged to lose weight BEFORE their operation and should consider delaying referral for non-urgent elective surgery; this is particularly applicable to patients who have a BMI over 40 or those with a BMI between 30 and 40 who have metabolic syndrome-a combination of diabetes, high blood pressure and obesity.
Patients should aim to reduce their weight by at least 10% over 9 months or to a BMI of less than 30.
See also Anaesthesia and your weight Royal College of Anaesthetists