Smoking cessation and bone healing: optimal cessation timing

  • Jeremy TruntzerEmail author
  • Bryan Vopat
  • Michael Feldstein
  • Amir Matityahu
General Review


Smoking is a worldwide epidemic. Complications related to smoking behavior generate an economic loss around $193 billion annually. In addition to impacting chronic health conditions, smoking is linked to increased perioperative complications in those with current or previous smoking history. Numerous studies have demonstrated more frequent surgical complications including higher rates of infection, poor wound healing, heightened pain complaints, and increased pulmonary morbidities in patients with a smoking history. Longer preoperative cessation periods also seem to correlate with reduced rates. At roughly 4 weeks of cessation prior to surgery, complication rates more closely reflect individuals without a smoking history in comparison with those that smoke within 4 weeks of surgery. In the musculoskeletal system, a similar trend has been observed in smokers with higher rates of fractures, nonunions, malunions, infections, osteomyelitis, and lower functional scores compared to non-smoking patients. Unfortunately, the present literature lacks robust data suggesting a temporal relationship between smoking cessation and bone healing. In our review, we analyze pseudoarthrosis rates following spinal fusion to suggest that bone healing in the context of smoking behavior follows a similar time sequence as observed in wound healing. We also discuss the implications for further clarity on bone healing and smoking cessation within orthopedics including improved risk stratification and better identification of circumstances where adjunct therapy is appropriate.


Smoking cessation Bone healing Wound healing Cigarettes 


Conflict of interest

The authors have no relevant financial relationships to disclose.


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Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Jeremy Truntzer
    • 1
    Email author
  • Bryan Vopat
    • 1
  • Michael Feldstein
    • 2
  • Amir Matityahu
    • 2
  1. 1.Department of Orthopaedics, Rhode Island HospitalBrown UniversityProvidenceUSA
  2. 2.Department of OrthopaedicsUniversity of California, San FranciscoSan FranciscoUSA

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