Smoking and postoperative pulmonary complications. An evidence-based review of the recent literature.

Postoperative pulmonary complications (PPC) lead to significant morbidity after both thoracic and non-thoracic surgical procedures. The role of smoking as an independent risk factor is controversial, though recent level III and IV studies suggest that it may indeed be significant. In addition, the role and timing of pre-operative smoking cessation is not clear. Although some studies suggest that abstinence too soon prior to operation may actually increase the risk of PPC, it still appears that aggressive counseling for smoking cessation prior to any elective procedure is the best overall course of action.