Failure to quit smoking before certain elective procedures confers such clinical detriment that to proceed to surgery is ill judged. When all other clinical features are identical, costs are increased and outcomes are worse in a smoker than in a current non-smoker. In healthcare systems with finite resources, preferring non-smokers over smokers for a limited number of procedures will deliver greater clinical benefit to individuals and the community—smokers and non-smokers. To fail to implement such a clinical practice in these select circumstances would be to sacrifice sensible clinical judgment for the sake of a non-discriminatory principle.

Smoking up to the time of any surgery increases cardiac and pulmonary complications,1 2 impairs tissue 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 intended procedural outcomes and increase the costs of care. Therefore, as long as everything is done to help patients to stop …