Post Surgery

How Can Smoking Affect Bariatric Surgery?

by Anthony Benjamin on Oct 12, 2022

How Can Smoking Affect Bariatric Surgery?

How Can Smoking Affect Bariatric Surgery?

No smoking before or after bariatric surgeryDid you know that tobacco use is the leading cause of preventable death in the United States, followed by obesity? You may be even more shocked to learn that current research suggests that between 12.9 to 38% of bariatric candidates are regular tobacco users. Unfortunately, bariatric surgery risks double with tobacco users, meaning you’re twice as likely to experience serious surgical complications. In this blog, we’ll be discussing how smoking can affect bariatric surgery. Keep reading to learn why it may be time for you to put those cigarettes away for good.

What Are the Surgical Risk Factors?

Smoking may increase surgical complications, such as blood clots, pneumonia, marginal, ulcers, and surgical wound infections. Smokers have an almost 30% complication rate after weight loss surgery. After surgery, smoking may also inhibit your ability to lose weight, heal, and will negatively influence your health in other ways.

Smoking, in general, is not a healthy habit. It restricts organ functions and increases your risk of developing conditions like heart attacks, strokes, lung disease, cancer, surgical wound infections, and others. Smoking also makes exercising challenging, a crucial part of living a healthy life post-bariatric surgery. You see, smoking decreases one’s stamina, leading to unproductiveness as carbon monoxide replaces oxygen in the body.

Because of higher complication rates during and after surgery, the potential for prolonged hospitalization and the need for higher dosing of opioid medication also increases.

Overall, there are many risks associated with smoking. However, bariatric patients need to be even more careful because their weight also influences how their bodies react to the surgery. Keep reading to learn, in more detail, just what exactly you’re putting yourself at risk for when you smoke leading up to your bariatric surgery.

Delayed Healing

As far as recovering from surgery goes, smoking can also inhibit how your stomach heals. Tobacco shrinks blood vessels, decreasing blood flow to the patient’s new stomach. Carbon monoxide also reduces the ability of red blood cells to carry oxygen throughout the body. These factors will cause a much slower healing process after the patient undergoes surgery, which will continue to be a concern for years to come. Sometimes the complications are so severe that surgery is required. The bariatric surgery may need to be revised or, if complications are severe enough, be reversed entirely (as in the case of a gastric bypass).

Respiratory Complications 

There is a proven link between smoking and respiratory-related complications after bariatric surgery. One study shows that patients who smoke within a year of their surgery are more likely to develop pneumonia. Another study showed that patients who had not smoked the year before their surgery but had a history of a 20 pack per year habit were at a greater risk of failing to wean from the ventilator within 48 hours of surgery than those with no smoking history.

Venous Thromboembolism (VTE)

A deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in the lower leg, thigh, or pelvis. Having surgery and being non-mobile can increase the risk of blood clots due to immobility. You’re most likely to get a clot between 2 and 10 days after your surgery, but your odds are higher for about three months. A more serious condition can result from a DVT called a Pulmonary Embolism (PE). A PE occurs when a clot breaks loose and travels through the bloodstream to the lungs. One study suggests that those who smoke have a 23% increased risk of developing VTE than non-smokers. The same study further demonstrates that the more packs of cigarettes you smoke a day, the more you increase your risk of developing VTE.

Marginal Ulcers

Marginal ulcers can develop after weight loss surgery, with gastric bypass surgery being the most common for complications post-op, especially if the patient is a smoker. In the case of a marginal ulcer with gastric bypass, there is the development of mucosal erosion in the area where the gastric remnant or distal stomach is stapled (most commonly at the gastrojejunal anastomosis). Patients who develop marginal ulcers should expect abdominal pain, nausea, vomiting, dysphagia (difficulty swallowing), and hematemesis (regurgitation of blood).  Research demonstrates that having a history of smoking at least a pack a day not only increases your risk of developing marginal ulcers but also experiencing a recurrence of marginal ulcers up to 12 months after surgery.

Smoking Statistics

Studies show that nearly one in seven adults smoke the year before surgery. However, almost all of them successfully quit at least a month before their surgery. Unfortunately, evidence proves that smoking prevalence steadily reaches pre-surgery within seven years post-surgery. Findings suggest missed opportunities to engage patients in interventions to improve long-term cessation rates.

Looking at the latest evidence of tobacco’s effect on bariatric patients, bariatric surgery guidelines recommend tobacco users quit at least six weeks before their surgery date. There are also recommendations to provide tobacco users with the necessary support to maintain long-term abstinence.

One fear of many patients that smoke is that they’ll gain weight if they stop smoking, jeopardizing their candidacy for surgery.  Assuring that patients are aware of the requirements for surgery and enacting strategies to minimize such conflicts will further the patient’s long-term tobacco cessation.

Research suggests that effective cessation six to eight weeks before can reduce the risk of postoperative complications. Tobacco cessation interventions that are more intensive (four to eight weeks) and utilize a combination of treatments have proven to be more effective than less intensive interventions. Professionals also recommend relapse prevention counseling and ongoing support post-surgery to ensure the patient maintains optimum health.

Some people may choose to pick up smoking post-surgery. A recent study showed that gastric bypass increases exposure to the psychoactive nicotine metabolite cotinine. Cotinine promotes addiction in many people. However, other risk factors could cause someone to pick up smoking, such as having smoked previously, younger age, being married or living as married, and drug use.


At this point, you should know that smoking may contribute to habits that may not potentiate the new lifestyle you are reaching for. We highly suggest that if you are a smoker that you find programs or support systems to help you quit, especially if you are to undergo any type of surgical procedure. From cardiovascular to gut health, there are many reasons why you should stop smoking long before any kind of bariatric measures are taken. You don’t want to become just another statistic about the dangers of smoking. Act today to live a healthy life. One day, you’ll thank yourself for it.

Go With ProCare Health for Your Bariatric Support

At ProCare Health, we know how important it is to maintain optimum health for a long and happy life. We offer products and information to help you make informed decisions about your health. Check out our live events through our Crowdcast Channel that advises on how to live a life full of healthy choices. We’re here for you. Contact us today with any comments or questions you may have!