Is vaping as risky as smoking before surgery, and are nicotine patches safe to use?
⚠️ Contact your surgeon or seek care if you notice these warning signs after surgery
Breathing difficulties, a wound that is not healing, increasing redness or discharge at the incision site, or chest pain after surgery are not normal. Contact your surgical team promptly or go to an emergency room if these occur.
Short answer
Vaping before surgery does carry real risks, especially for wound healing, though current data suggest the pulmonary risks may be slightly lower than traditional smoking. Nicotine replacement therapy (NRT) such as patches appears to be safe perioperatively and is generally recommended over continuing to smoke or vape. Stopping all nicotine products before surgery is still the safest choice when possible.
What the research shows about vaping before surgery
A large retrospective study of over 110,000 patients found that vaping was associated with a small but statistically significant drop in blood oxygen levels in the first hour after surgery, though it did not significantly increase the rate of lung complications overall. [1] However, a systematic review of 37 studies on wound healing concluded that vaping likely impairs tissue repair in ways similar to traditional cigarettes, and experts recommend treating e-cigarettes the same as tobacco in the perioperative period. [2] A smaller pilot study in foot and ankle surgery could not find a statistically significant difference in complication rates between vapers and smokers, though the study was too small to draw firm conclusions. [3]
What the research shows about nicotine patches
Nicotine replacement therapy (NRT), including patches, has been reviewed specifically for surgical safety. A narrative review found no evidence from human studies that NRT increases the risk of healing or cardiovascular complications around surgery, and concluded that policies banning NRT in surgical patients should be reconsidered. [6] A review focused on dermatologic surgery similarly found that human studies show no detrimental effect of NRT on perioperative complications, and recommended that surgeons consider NRT for smokers, while discouraging e-cigarettes as a form of NRT. [7] A small pilot randomized trial comparing nicotine patches to e-cigarettes for preoperative quit attempts found comparable quit rates on the day of surgery for both approaches. [4]
What this means for you
Ideally, stopping all smoking, vaping, and nicotine products well before surgery gives your body the best chance to heal. [2] If quitting cold turkey is difficult, nicotine patches are considered a safer bridge than continuing to smoke or vape, and they can support your quit attempt. [6] [7] Real-world data suggest that many patients are not routinely offered cessation advice or NRT prescriptions before surgery, so it is worth proactively asking your surgical team about your options. [5]
What to ask your surgeon
Ask your surgeon or anesthesiologist: How far in advance should I stop vaping or smoking before my procedure? Would a nicotine patch be appropriate for me, and what dose? Are there any concerns specific to my type of surgery, such as flap reconstruction or bone healing, where nicotine of any kind may carry additional risk? [7] [2]