Intended for healthcare professionals

Letters Detrimental effects of e-cigarettes

It is preferable for surgical patients to use e-cigarettes rather than smoke cigarettes

BMJ 2014; 348 doi: (Published 10 March 2014) Cite this as: BMJ 2014;348:g1961
  1. Konstantinos Farsalinos, cardiologist-researcher1,
  2. Vassilis Voudris, cardiologist and director1
  1. 1Onassis Cardiac Surgery Centre, Kallithea 17674, Greece
  1. kfarsalinos{at}

The title of Holmes and Southern’s letter led us to expect descriptions of case reports on the detrimental effects of e-cigarettes and an attempt to associate such effects with the use of e-cigarettes.1 Instead, the letter just mentions the theoretical adverse effects of e-cigarettes on surgical outcomes and is not backed by any kind of evidence.

The authors seem to confuse the effects of nicotine and smoking. Some of the studies they cite make it clear that nicotine has minimal, if any, adverse effects on wound healing compared with those of smoking.2 3 One study noted raised tissue oxygen tension after nicotine infusion, in contrast to the reduction seen after smoking.2 Another study by the same group found that smoking cessation improved wound healing irrespective of whether a nicotine or placebo patch was used as a smoking cessation aid.3 With regard to e-cigarettes, the vapour from 20 e-cigarettes was shown to have minimal cytotoxic effects on skin fibroblasts.4

The incidence of smoking is about 30% in general surgical populations undergoing elective procedures.5 Obviously, clinical studies need to be performed to determine the effects of e-cigarette use on surgical outcomes. However, currently available evidence suggests that it would be preferable for smokers to use e-cigarettes rather than smoke during the preoperative period.6 In any case, the title of Holmes and Southern’s letter is misleading when you consider the letter’s contents.


Cite this as: BMJ 2014;348:g1961


  • Competing interests: The authors have performed studies on e-cigarettes, for some of which the institution had received unrestricted funding from e-cigarette companies.


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