Should smokers be refused surgery?

doi:10.1136/bmj.39059.503495.68

BMJ 2007;334:20 (6 January), doi:10.1136/bmj.39059.503495.68

feature

Head to head

Should smokers be refused surgery?

Matthew J Peters, associate professor

¹ Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord NSW 2139 Australia

matthew.peters@cs.nsw.gov.au

Last year a primary care trust announced it would take smokersoff waiting lists for surgery in an attempt to contain costs.Matthew Peters argues that denying operations is justified forspecific conditions but Leonard Glantz believes it is unacceptablediscrimination

The first 150 words of the full text of this article appear below.

Failure to quit smoking before certain electiveprocedures confers such clinical detriment that to proceed tosurgery is ill judged. When all other clinical features areidentical, costs are increased and outcomes are worse in a smokerthan in a current non-smoker. In healthcare systems with finiteresources, preferring non-smokers over smokers for a limitednumber of procedures will deliver greater clinical benefit toindividuals and the community—smokers and non-smokers.To fail to implement such a clinical practice in these selectcircumstances would be to sacrifice sensible clinical judgmentfor the sake of a non-discriminatory principle.

Smoking up to the time of any surgery increasescardiac and pulmonary complications,¹ ² impairstissue healing,³ and is associated with more infections³ ⁴ ⁵ ⁶ ⁷ and other complications at the surgical site.⁴ ⁷ These adverse effects compromise the intendedprocedural outcomes and increase the costs of care. Therefore,as long as everything is done to help patients to . . . [Full text of this article]

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Should smokers be refused surgery?: Leonard Glantz
BMJ 2007 334: 21. [Extract] [Full Text]

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Chapman, S, Freeman, B (2008). Markers of the denormalisation of smoking and the tobacco industry. Tobacco Control 17: 25-31 [Abstract] [Full text]

Rapid Responses:

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Surgeons should help smokers quit not punish those who can't.: Becky Freeman
bmj.com, 5 Jan 2007 [Full text]
Smokers will lie about their habit: Caroline Richmond
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Cotinine is validated: Ian N Ross
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Smokers do lie � but we have ways of identifying those who do and assisting them to quit: Graham F. Cope
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Separate Policies: Randall Anderson
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smokers and others ?: Patrick SILVESTRE
bmj.com, 6 Jan 2007 [Full text]
Surgery of peripheral arteriosclerosis: Finn Edler von Eyben, et al.
bmj.com, 7 Jan 2007 [Full text]
No: Andrew Montgomery
bmj.com, 7 Jan 2007 [Full text]
An Incomplete Argument For Denying Treatment: Mark Sheehan
bmj.com, 8 Jan 2007 [Full text]
What about the passive smokers?: Nicola N Noetic
bmj.com, 8 Jan 2007 [Full text]
Three Hurrahs for Professor Glantz: Evelyne Shuster
bmj.com, 8 Jan 2007 [Full text]
An Incomplete Argument For Denying Treatment: Matthew Peters
bmj.com, 9 Jan 2007 [Full text]
Smoking is a disease: D William Cameron, et al.
bmj.com, 9 Jan 2007 [Full text]
Re: An Incomplete Argument For Denying Treatment: L S Lewis
bmj.com, 10 Jan 2007 [Full text]
Re: Separate Policies: Walt Cody
bmj.com, 11 Jan 2007 [Full text]
Utility vs. Autonomy: Kiaran Asthana
bmj.com, 11 Jan 2007 [Full text]
Re: Re: Separate Policies: Randall Anderson
bmj.com, 12 Jan 2007 [Full text]
Should smokers be refused surgery?: Mohammad I Khalid
bmj.com, 15 Jan 2007 [Full text]
Primum non nocere: Jac Ciampolini
bmj.com, 15 Jan 2007 [Full text]
Re: Re: Re: Separate Policies: Walt Cody
bmj.com, 17 Jan 2007 [Full text]
Smokers pay more taxes in the UK thus covering their extra care costs.: Marise A McQueen
bmj.com, 2 Nov 2007 [Full text]