Preoperative Risk Factors

Smoking & Nicotine Use

Smoking causes lung disease and contributes to fracture nonunions, wound healing, higher rates of infection and many other side effects.


Increases a person’s risk for orthopaedic injuries and diseases, such as fractures and osteoporosis.

Reduces blood supply to bones, slows production of bone-forming cells, and decreases the body’s ability to absorb calcium from the diet

Increases a patient’s risk for pulmonary complications after receiving general anesthesia

Complications include:

  • decreased pulmonary function
  • poor tissue oxygenation
  • infection
  • wound healing
  • cardiovascular events

Surgeon Tools/Recommendations

  • Testing patients on the day of surgery for evidence of smoking with the nicotine blood test. (i.e. cotinine test).
    • Nicotine metabolized to cotinine in liver and may remain present for up to 10 days after nicotine usage.
  • Utilize the Smoking Cessation Checklist that documents whether the patient is a current smoker or former smoker.
  • Recommend patients to quit smoking at least 4-6 weeks prior to elective surgical procedures and least 6 weeks following the surgery.
  • Provide patients with the Quit Smoking Before Your Operation, for patients to develop an action plan to quit.