Force smokers to quit before surgery: agency

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.

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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.