Nicotine and surgery

Originally Published: February 24, 2006 - Last Updated / Reviewed On: September 9, 2009
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Dear Alice,

I'm going to have back surgery in a few months. I'm not suppose to smoke for two weeks before surgery. The doctor is going to do a nicotine test to see if I've been smoking. How long does it takes for nicotine to be completely out my system?

Could really use a cigarette!

Dear Could really use a cigarette!,

It is a common practice for health care providers to request that their patients not smoke for a given period of time before an operation.  By asking you to refrain from puffing, your provider wants to make certain that you are at your healthiest before making the first incision. 

Current scientific research backs your provider's desire for you not to smoke due to its negative effects during and after surgery.  Multiple studies have found that individuals who smoked within 24 hours of surgery had decreased blood flow to the heart compared to those who had not smoked before their surgery.  In addition, patients who didn't smoke were approximately six times less likely to suffer from problems with wound healing, and on average were kept in the hospital for two days less than those who continued to puff away prior to surgery.

While nicotine will usually clear your system within a day, the byproducts of smoking, namely carbon monoxide and other chemicals in cigarettes, take longer (usually about 2 weeks) to leave the body.  These chemicals have been shown to interfere with healing by preventing blood from clotting, slowing down the speed of tissue growth, and inhibiting the body's natural immune system.  The test that your medical provider will do to see if you've been smoking is probably a blood, urine, or saliva test for cotenine (a byproduct of nicotine) or a carbon dioxide test that is done by having you breathe into a machine that will test your respiration.  Ensuring a successful surgery means, in part, healing well, and keeping carbon monoxide and the other chemicals in tobacco smoke out of your body prior to and while you recover from surgery is a big part of that.

Quitting smoking takes a lot of hard work, but the result will pay off in terms of your health.  Consider checking out an online program like or call 1-800-QUITNOW to get help quitting.  Columbia students can also take advantage of the tobacco cessation program on campus.  If you haven't already, it may be a good idea to talk to your health care provider or a counselor about tobacco cessation and nicotine replacement therapies before you go into surgery.  S/he may be able to recommend a plan before you go under the knife.