Cigarette smoking contributes to significantly higher hospital expenses for smokers undergoing elective general surgery, according to a new study.

Researchers at the University of Iowa Hospitals and Clinics (Iowa City, USA) analyzed data on 14,853 patients who had undergone a general surgery operation in 123 Veterans Affairs (VA) Medical Centers during a one-year period. The patients were classified into one of three groups: 34% were current smokers, 39% were former smokers (patients with a history of smoking, but who did not smoke during the year before their operation), and 27% were never smokers. The researchers then examined hospital costs in three areas: the operation itself, subsequent readmission within 30 days of discharge, and length of hospital stay.

The results showed that total inpatient costs were 4% higher for current smokers compared with patients who never smoked, resulting in a higher cost of approximately USD 900 for each patient who underwent a surgical procedure. The same was not true for former smokers, for whom costs were not statistically significant compared with patients who never smoked. After factoring in the complexity of the operation, researchers found that hospital costs for smokers who had more complex procedures were 6% higher compared with hospital costs for patients who never smoked. The study was published in the June 2012 issue of the Journal of the American College of Surgeons.

“This research just strengthens our belief that we should encourage patients to quit smoking before their operations because of respiratory complications, in order to improve their surgical outcomes,” said lead author Aparna Kamath, MD, MS, of the department of internal medicine. “In addition, it provides health care stakeholders and decision makers with data to make a business case for preoperative smoking cessation interventions.”

“Although our research did not directly address this issue, evidence suggests that quitting smoking before an operation, even as little as four to six weeks prior to the procedure, improves postoperative outcomes and decreases complications in patients,” added Dr. Kamath. “I think it's important to use the time before a surgical procedure as a teachable moment.”

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