• Sweden edition
 

Force smokers to quit before surgery: agency

Published: 27 Nov 2009 15:43 GMT+01:00
Updated: 27 Nov 2009 15:43 GMT+01:00

Surgeons should be able to demand that a patient refrains from smoking in the period before and after an operation, the director-general of the Swedish Welfare Board (Socialstyrelsen) argued on Friday.

The requirement should be just as natural as requiring weight loss or nil by mouth, Lars-Erik Holm argued to the Svenska Dagbladet newspaper in regard to new guidelines which the Welfare Board plans to issue next year.

The director-general added that the recommendation was to be made on the proviso that anti-smoking help was made available to the patient.

Holm cited the orthopaedic clinic at Norrland University Hospital in Umeå in northern Sweden as a positive example.

The hospital introduce a smoking ban as a condition for all surgery six months ago. The hospital stipulates that a patient should not smoke in the two months before and after a surgical procedure.

Several studies, including one at Stockholm South General Hospital, demonstrate that the risks for complications after both major and minor surgery decrease considerably with the enforcement of a smoking ban.

Holm argues that a smoking ban would be an important measure in connection with all operations - to cut the risk for complications by up to half, and to increase the chances of successful surgery.

"Healthcare services have been vague regarding this issue previously. We now know so much more - that even simple procedures are associated with a far higher risk for complications if the patient smokes."

"It should perhaps be regarded in the same way as demanding that a diabetic keep a check on blood sugar levels, or an overweight person is required to lose a few kilos, or control their blood pressure before an op," Holm said.

Lars-Erik Holm is careful to point out that health authorities are not demanding that the patient gives up smoking for the rest of their lives and that the recommendation concerns "a couple of weeks before and a couple of weeks after" an operation.

When asked how the demand for abstinence from smoking conforms with the equal rights of the patient to care, Holm responded that in emergency cases even smokers would be operated on.

"It is a question of conducting a dialogue with the patient, so that he or she understands that this is done to reduce the risk of infection, to assist healing."

Lars-Erik Holm told the newspaper that the proposal was not an example of an over-protective "Big Brother" attitude, but instead was an expression of care for the individual's health and welfare in connection with an operation.

"If the patient, despite everything, refuses, then it is important that she or he understands that they deliberately expose themselves to a greater risk," he said.

TT/The Local (news@thelocal.se)

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Your comments about this article

17:13 November 27, 2009 by Nemesis
This is a good idea.

Everywhere I go in Sweden I see teenagers and young adults with a cigarette in there mouth.

Smokers use up more hospital time and require social services more often.

Any measure to reduce smoking is a good thing for all in society.
17:47 November 27, 2009 by Greg in Canada
It amazes me that people still smoke in this day and age with all that is known about how it affects your health in such a negative way.

You could put the most beautiful woman in the world in front of me, but if she is a smoker I wouldn't be interested in her. Who wants to kiss an ash tray.
18:38 November 27, 2009 by ingvar
2 Greg: you are such a funny child.
18:50 November 27, 2009 by Plowbridge
Greg, you would be lucky to kiss someone who looks like an ashtray let alone smells like one.
19:55 November 27, 2009 by peropaco
It amazes me than in this day and age people still have unprotected sex with all that is known about the risk of STD. Maybe fat brother should force people to wear condoms before engagin in carnal satisfaction. Maybe we could appoint a few of the above posters to head up the condom patrol?
21:40 November 27, 2009 by Keith #5083
Not an unfair suggestion - and I am a smoker! However, do they also intend to extend these regulations to alcohol? I understand the costs to european health services relating to alcohol are 6 times the costs relating to smoking. This is NOT a defence of smoking, simply a desire to make some balance in so-called 'expert medical opinions'.

Oh, Greg, just out of curiosity, do you drink alcohol?
22:26 November 27, 2009 by spy
What a nanny state!

Smokers pay a disproportionate amount of tax compared to the health care they receive. What is all the fuss about? Conversely if I was to go under the knife I would be happy if the surgeon smoked whilst doing the operation (as long as he/she didn't put ash in my wound).
22:33 November 27, 2009 by Rick Methven
I am trying to give up the evil weed. I snus instead!

But as far as drinking is concerned.....

I will always have my daily single malt!!!!
06:08 November 28, 2009 by Greg in Canada
@ Ingvar, Plowridge, Keith, et al

If you want to smoke that's OK, but face the health consequences later in life. If you want to shorten your life that's fine, but why should I breath your second hand smoke in public places.

What does drinking have to do with smoking? Moderate drinking will extend your life based upon scientific research .

I watched my father in law die of lung cancer from years of smoking. It's not a pretty site.

Think about it.

.
09:31 November 28, 2009 by Keith #5083
@ Greg

In the same manner in which you have graciously extended caring to me about my (almost minimal but indefensible) smoking habit, I would remind you that 'big tobacco' also said that smoking was beneficial and not harmful.Check out the funding for many of these 'alcohol related reports' you refer to.

Your reference to the 'theoretical and unproven benefits' of alcohol extending life are now seriously questioned. There is clear evidence of damage to cells in foetus's of 'drinking mothers' and equally clear evidence of brain/liver/kidney damage in adults.

My point is simply that there is a disproportionate 'puritanicalism' by some in the medical profession about smoking. That neither of these activities are especially healthy is clear - but it is 'in vogue' to penalise smokers and not drinkers or obese over-eaters. This fashion will pass in time.

I do not smoke indoors, not even in my own home, and I do not feel that prevailing winds drift my smoke as far as Canada. Clearly, at 65 years of age, you can be sure that I have witnessed many die of cancer and have given much thought to the issue.

But I guess they wouldn't operate on me because I was exposed to trichlorethylene fumes for a reasonable period in my youth.It's beginning to sound like American health Insurers, if you ever coughed once - then we won't operate!!!!
09:42 November 28, 2009 by Steggles
With my work I frequent the local hospital daily.

It amazes me the number of patients who are outside smoking.....supposedly sick or dieing!
10:44 November 28, 2009 by futureishere
Keith,

I agree with you about unbalanced puritanical-ism between smoking and alcohol. And this imbalance is skewed in favor of smoking in some parts of the world, where alcohol is prohibited but smoking is allowed.

We live in an imperfect world where ideal solutions and ideal policies don't work. The imbalance in government's policies towards different abusive substances will always exist. The logic that if we allow one evil then we should allow all (or vice versa) doesn't really work. But what does work is the will of majority. So if the majority want stricter measures against smoking but not alcohol, that's how its going to be.
11:02 November 28, 2009 by Marley420
There is no scientific test that can show or prove a patient smoking the day before or day after surgery....
12:26 November 28, 2009 by livinginsweden
Hej ... smoke and drink as much as you want .. the world is too crowded.

By the way, this is Sweden , we have freedom to "slicka fitta på morgonen och suga kuk på kvällen om man har lust". and drink and smoke too...

ha ha
19:54 November 28, 2009 by izbz
Been smoking more years than your toes and fingers add up together. Have always smoke away from crowd or among smokers but if a non smoker will to come near me while I am smoking, I am not gonna stamp my cigarette off, because the non smoker choose to be beside me.

Maybe one day I'll kick the bucket with lung cancer or maybe I might quit. I really do not condemn those who drink or smoke. Choice lies in our own hands.--' Bad things always comes together with bad habits 'example: Have you ever been so drunk that you were embarassed by things you did (piss drunk)when you sober up? Have you ever heard of a dumb drunk beating up his wife or kids?
20:11 November 28, 2009 by CanadianEh
I have noticed more people in Scandanavia Smoke then anywhere else I've travelled to. I think there reason is there is nothing else to do. You can't really start a conversation here in Sweden with a random stranger unless you or both are drunk out of your wits. (Get with the program and develop social skills.)

Back to the real topic though, yeah it's a good idea however how in the world are you going to police that?

Yeah kinda sad that Swedes will eat pussy and then suck a cock but they forgot to add - while drunk.
20:28 November 28, 2009 by spy
CanadianEh

"I have noticed more people in Scandanavia Smoke then anywhere else I've travelled to" - well you obviously haven't travelled very extensively then - I have and I think exactly the reverse.

But I did laugh at your last sentence - so true!!
20:36 November 28, 2009 by izbz
@CanadianEh

Go to Asia, you can see people smoking anywhere and everywhere.... except Singapore, maybe because it is a FINE country. Fine you for smoking at certain place, fine you for chewing gum, fine you for sitting at the wrong seat in the cinema(I was fine for that). Such a Fine country that they will find ways to fine you.

Maybe you haven't travel so much after all.
22:05 November 28, 2009 by karex
Well the main reason why smoking places a greater risk after surgery is because of the increased risk of infection due to longer healing period. This is because smoking affects blood circulation and the better the blood circulation the faster the healing. Ergo, longer healing period increases the risk of infection.

No, I'm not a doctor but I was engaged to a surgeon who loved to talk about his work...

In any case, it is a bit out of character for a society so fixated on "fairness" to single out smoking. There are a number of conditions which affect good blood circulation as well as other acquired habits as pointed out in other comments.

OK, so about other conditions and ilnesses there's nothing they can do anything about. But to single out one among several acquired habits seems to be a bit out of character to me.
08:34 November 29, 2009 by CanadianInSweden
iv lived in 8 countrys so far and i find less people smoke here then anywhere iv lived before...go to greece or spain or italy...you would think the whole population smokes! and in most places there you can still smoke pretty much where ever u want..bars/resturants...and they have the law also..just dont enforce it..i dont know about sweden but just the taxes on ciggs in canada pays for a majority of the whole healthcare system,if everyone quit the system would go bankrupt..its a very bad argument to say smokers cost the system so much...in a private healthcare system sure say u cant smoke around the time of a surgery..in a social system which is a right as a citizen as long as smokes are legal i dont think they should be able to tell you not to.
00:20 November 30, 2009 by TvAmazon
This is one of the problems with socialized medicine. If everyone is going to pay for your benefits then they should have a say at how you use those benefits. If you smoke against the doctors orders then maybe they should pay for the bills.

In America even though we are far from perfect. Your doctor will talk to you or get mad and scream but in the end the individual is the one paying for it and if they want to kill themselves then it is their choice. We assume they are sane adults and can choose how to behave and also accept the consequences. It's not taking advantange of anyone but themselves. It's time for Sven to be an adult and get the bill if doesn't like the rules.
08:41 November 30, 2009 by Da Goat
As karex says it has nothing to do with the smoking or drinking for that matter (or sucking or licking LOL)

it is about the surgeons wasting their precious time (they charge a arm and a leg you know) on smokers they simply don't heal and are harder to operate on (I would guess snus is the same deal)

if you can get the patient off the evil weed for some time the hospital resources are better utilized, the patient is in and out quicker with less cost to everyones (including the smoker) pocket and more people (again the smoker too) can be squeezed into the medical system.

Now if the smoker has any brains they will also try to stay off the weeds when they get the opportunity to do so and put the money into something better !
11:36 November 30, 2009 by Britswedeguy
Smoking - you're stupid to start, weak if you don't stop.

And judging by some of the comments here, childish and bitchy too!

Man up, grow a pair and quit your disgusting addiction.
14:05 November 30, 2009 by sparkusprime
@britswedeguy -

To some, the 'disgusting addiction' is an enjoyable pastime. To say people are weak if they don't stop is a little childish as well, no? It's a fair point that the smoking itself is dangerous for your health and the health of people around you, but if people choose to light up a smoke because they enjoy it I'm not going to call them a weak idiot. I'm sure some non-smokers have habits others find repulsive as well.

Besides, if smoking kills, and everyone who smokes is weak and an idiot, then couldn't you assume that cigarettes are just getting rid of the weak and idiotic? everyone wins! (except the so called weak and idiotic)

now...where was I... Ah yes. flavor country.
19:56 November 30, 2009 by izbz
@Britswedeguy

Judging by your comment, you sound pretty childish and bitchy yourself. Like sparkusprime stated: maybe you might have some repulsive habits that others don't like.

Seems you might be one of those who have never start...so bravo. So I guess you will never know what a smoker goes thru' when try to stop.

Like some say smoking stinks, yeah sure I don't even smoke inside my own apartment. But I can say that Cheap perfume stink and body ordor stink more than cigarette smell. But I would never call a person using cheap perfume stupid, I can only advice them if they can't bloody afford good perfume, not to use any instead.
12:34 December 1, 2009 by Britswedeguy
@sparkusprime - one of the problems with smoking is that it doesn't kill quickly enough. Smokers often live into their 50s, stinking up the air with cancer-causing chemicals. As for paying for their inevitable health care through taxes, the numbers don't add up - until you add in the money saved on pensions through early deaths.

@izbz - I think you just proved my points! And my repulsive habits never affect anyone else's health or comfort.
15:24 December 2, 2009 by Stephygirl1
Leave Smokers alone, non smokers forget smoking is legal. People seem to have more tolerance to cronic drug addicts than to smokers. Lots of people in the medical profession smoke. Lets pick on the Alcoholics and the Obese this week.

You only live once, you have to die of something!
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