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by Adam Brown  BScPT, MClScPT
updated Apr 30, 2024

At this point we all know that smoking is bad for our health. The data are unequivocal that there is a strong link to cancer, heart disease and other illnesses. Rates of smoking have been declining over time but according to stats Canada 13% of the Canadian population over the age of 15 still identify as smokers. That equates to almost 5 Million Canadians over the age of 15 that are smokers.

One often overlooked consequence of smoking is that it significantly impairs the body’s natural ability to heal from injuries and surgeries. In this article, we will delve into the mechanisms through which smoking hampers the healing process, backed by current scientific studies.


1. Smoking and Wound Healing

Wound healing is a complex biological process involving multiple stages, including inflammation, tissue formation, and tissue remodeling. Smoking disrupts each of these stages, prolonging the overall healing process.

Inflammation: Inflammation is a fundamental response to injury, initiating the healing cascade. However, smoking triggers excessive inflammation, leading to delayed wound closure and increased susceptibility to infections[^1^].

Tissue Formation: Nicotine, a key component of cigarettes, constricts blood vessels, reducing oxygen and nutrient supply to the healing tissues. This reduced blood flow impairs the formation of new tissues, slowing down the healing process[^2^].

Tissue Remodeling: Proper wound healing involves remodeling of tissues for optimal function. Smoking disrupts collagen synthesis, a crucial component of tissue remodeling, leading to weak and easily damaged tissues[^3^].


2. Smoking and Bone Healing

For individuals undergoing orthopedic surgeries or dealing with fractures, smoking poses significant challenges to bone healing.

Delayed Fracture Healing: Studies have shown that smokers experience delayed fracture healing due to impaired blood flow and reduced osteoblast (bone-forming cells) activity[^4^].

Increased Risk of Complications: Smokers are at a higher risk of post-surgical complications such as non-union (failure of bones to heal) and infections, necessitating additional surgeries and prolonged recovery periods[^5^].


3. Smoking and Surgical Procedures

Smoking before and after surgery significantly elevates the risks associated with various procedures.

Postoperative Complications: Smokers face higher rates of postoperative complications, including wound infections, pulmonary complications, and cardiovascular events[^6^].

Impaired Immune Response: Smoking weakens the immune system, making smokers more susceptible to infections after surgery. This compromised immunity hinders the body’s ability to fight off pathogens and slows down the healing process[^7^].


4. Smoking Cessation: A Ray of Hope

Despite the grim picture painted by the impact of smoking on healing, not all hope is lost. Quitting smoking can significantly improve the chances of successful recovery.

Enhanced Wound Healing: Studies have shown that individuals who quit smoking before surgery have better wound healing outcomes compared to active smokers[^8^].

Reduced Complications: Quitting smoking before surgery reduces the risk of postoperative complications, making the recovery process smoother and more successful[^9^].

It is worth noting that quitting smoking is not easy! But it may be worth the effort, especially if you are facing injury, surgery or a recovery from another illness. The detrimental effects of smoking on healing from injury or surgery are undeniable. From impairing wound healing to delaying bone regeneration and increasing the risk of postoperative complications, smoking casts a long shadow over the recovery process.


At Cornerstone we are here to support our patients’ recovery process whether they are a smoker or not. We will consider smoking history when developing a prognosis and timeline for recovery to provide the most accurate information possible. We may also encourage smokers to reduce or eliminate smoking if they are interested in how they might improve their recovery from injuries and surgeries.



[1] Surgeon General’s Report: The Health Consequences of Smoking—50 Years of Progress.
[2] Raupach, T., et al. (2010). Impact of Smoking on Wound Healing: A Systematic Review.
[3] Sørensen, L. T. (2012). Wound Healing and Infection in Surgery: The Clinical Impact of Smoking and Smoking Cessation: A Systematic Review and Meta-analysis.
[4] Gaston, M. S., Simpson, A. H. (2007). Inhibition of Fracture Healing.
[5] Kessler, P., et al. (2018). Smoking is a Predictor for Complications in Femoral Fracture Healing.
[6] Thomsen, T., et al. (2014). Current Smoking is Associated with Delayed Wound Healing and Increased Infection Complications After Open Tibia Fracture Surgery.
[7] Arcavi, L., Benowitz, N. L. (2004). Cigarette Smoking and Infection.
[8] Møller, A. M., et al. (2002). Effect of Preoperative Smoking Intervention on Postoperative Complications: A Randomized Clinical Trial.
[9] Lindström, D., Sadr Azodi, O. (2010). Effects of a Perioperative Smoking Intervention on Postoperative Complications: A Randomized Trial.

About the author

Adam Brown

Co-founder, Physiotherapist Learn More about Adam Brown

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