Smoking, vaping and weight-loss surgery

If you smoke or vape, you have probably heard that you need to stop before weight-loss surgery. It can feel like one more hard thing on a long list. Here is why it matters, what studies show, and how to make quitting a little easier.

Why it matters

Smoke and nicotine affect your body in ways that matter during and after an operation.

• Smoke irritates the lungs and airways, which raises the risk of breathing problems and pneumonia after anesthesia.
• Smoking slows wound healing and raises the risk of problems with your incisions.
• Nicotine increases stomach acid and lowers blood flow to the lining of the stomach, which can lead to ulcers.

Canadian guidelines note that smoking or using nicotine now, or in the recent past, puts people at risk of complications after bariatric surgery.

What studies show

• In a U.S. database of more than 33,000 sleeves, people who had smoked in the year before surgery had more serious complications in the first 30 days than people who did not smoke: 0.9% compared with 0.6%. They were also more likely to need a breathing tube put back in.
• The risk was low in both groups, but it was higher for people who smoked.
• A review of randomized trials across many types of surgery found that quitting before surgery lowered the risk of complications by about 41%. Each extra week without smoking added to the benefit, and quitting for at least 4 weeks worked better than a shorter time.

How long before surgery?

Canadian guidelines say that stopping smoking before bariatric surgery is required, and that it should last for life. They note that surgical centres recommend at least six weeks, and up to six months, without smoking before surgery. Your team tells you the timeline that applies to you.

Staying smoke-free after surgery matters too. Canadian guidelines note that smoking after bariatric surgery may be linked with ulcers, pneumonia and more complications in later operations, such as body contouring.

What about vaping?

Vaping exposes you to much lower levels of harmful chemicals than cigarette smoke, but it is not risk-free. Health Canada notes that vaping nicotine is addictive and can raise your heart rate and blood pressure for a while. Vaping aerosol can contain harmful chemicals and metals that may damage the lungs, and the long-term effects are still being studied.

Canadian guidelines talk about nicotine, not only cigarettes. So tell your team if you vape, use nicotine pouches or gum, or smoke cannabis. Ask before you use any quit-smoking medicine or nicotine replacement, and ask when to stop it before surgery.

Getting help to quit

Quitting is hard, and it can take more than one try. You do not have to do it alone.

• Talk to your family doctor or pharmacist about quit-smoking medicines and support programs near you.
• Pick a quit date well before surgery, and tell your care team about it.
• Plan for your triggers, such as coffee, stress, driving or a break at work.
• Ask the people you live with to support you, and to keep smoke away from you and your home.