No smoking: Why many physicians refuse to operate on smokers — 8 takeaways

Practice Management

Physicians are turning smokers away with increasing regularity, according to The Charlotte Observer.

As research continues to shed light on the impact a patient's lifestyle has on a surgery's outcome and physicians' salaries, physicians are putting their foot down and starting a bold trend.


Here are eight things to know:


1. In addition to linking smoking to heart disease and cancer, recent research has proven that smoking stalls wound healing by disrupting blood flow.


2. A 2016 study published in Global Spine Journal revealed that non-smokers recover much better after spinal fusion surgery and joint replacements than smokers.


3. Smokers who undergo joint replacement surgery have an 80 percent higher chance of needing repeat surgery because of infections and complications.


4. Physicians are requesting that patients quit smoking or stop for specified periods of time before and after surgery on an increasingly frequent basis.


5. These recent developments have led to "surgical optimization," which is the physicians' term for making sure patients are as healthy as possible going into surgery. Patients with obesity or diabetes fall under a similar category and are often referred to nutrition counseling and other forms of treatment to improve chances of the surgery's success.


6. Bryan Edwards, MD, head of orthopedic surgery at Charlotte, N.C.-based Novant Health said, "If you're doing surgery, you're trying to get the bones to unite, and if you don't have good blood flow, the results aren't as good."


7. Surgical complications stemming from smoking, diabetes or obesity impact physicians' pay, and could potentially impact a surgeon's decision to use a fee-for-service system or a value-based system with a single bundled payment per patient encounter.


8. Leo Spector, MD, a spine surgery specialist at Charlotte, N.C.-based OrthoCarolina said, "A year from now, I'll probably be at a point where I would require all my patients to stop smoking… Currently, I evaluate it on a case-by-case basis. Over time, we're going to feel comfortable being a little more stringent with our patients about these modifiable risks."


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