Perioperative Nicotine Replacement Therapy for Surgical Patients

Safety and Efficacy

Meta-analyses of safety data from clinical studies with transdermal nicotine patches found no evidence of increased cardiac events associated with NRT treatment, according to the Mayo Clinic Proceedings 1
Advanced age, hypertension, and significant tobacco history place patients at high risk for postoperative pulmonary complications, with current smoking increasing hospital mortality by 20% and major postoperative complications by 40%, as reported by the Annals of Internal Medicine 2

Ideally, smoking cessation should begin 4-8 weeks before elective surgery to maximize cardiopulmonary benefit and reduce respiratory complications, as recommended by clinical guidelines 3
Immediate cessation with NRT should still be initiated if surgery cannot be delayed, as the benefits of abstinence begin accruing immediately for some outcomes 4

Combination NRT (nicotine patch plus gum or nasal spray) is more effective than monotherapy for some smokers, and higher-dose nicotine patch therapy (≥25 mg/d) may provide incremental benefit over standard dosing, according to the Mayo Clinic Proceedings 1
Intensive interventions combining counseling and pharmacotherapy (face-to-face or telephone counseling with NRT or varenicline) are most effective and reduce postoperative complications, as reported by clinical guidelines 3, 4

The American Heart Association and American College of Cardiology recommend continuing antihypertensive medications throughout the perioperative period to avoid complications from postoperative hypertension, and maintaining blood pressure control without contraindicating NRT use 5, 6

The evidence consistently shows a threshold effect at 4 weeks—shorter durations provide minimal benefit for respiratory complications, but any cessation is better than continued smoking, as reported by clinical guidelines 3