Vaping increases risk of surgery complications

E-cigarettes prevent wound healing: Study says patients should be banned from vaping for two months before surgery to avoid complications

• Vaping devices are tipped as safe alternatives to cigarettes because strip out the combustible chemicals of tobacco
• But a new study by Boston University shows vapes have the same effect
• The nicotine hampers the process where injured flaps of skin join together
• Surgeons warn patients who vape should be told to quit in the weeks before surgery 

Vaping prevents wounds from healing properly, warns new research.

Patients are already advised to stop smoking normal cigarettes for at least a month before operations such as plastic surgery.

Nicotine, the addictive ingredient, is known to restrict blood flow and raise the risk of of complications for cigarette smokers.

Although e-cigarettes strip out the combustible chemicals of tobacco, a new study shows the devices have the same effect, hampering the process where injured flaps of skin join together.

E-cigarettes strip out the combustible chemicals of tobacco, but a new study by Boston University shows vapes have the same effect, hampering the process where injured flaps of skin join together (file image)

The finding has implications for how doctors counsel patients before they go under the knife.

They need to consider the impacts of both traditional and battery powered cigarettes on their wound healing progress and safety, said the US team.

Study corresponding author Dr Jeffrey Spiegel, chief of facial plastic surgery at Boston Medical Center, said: ‘Based on our findings, e-cigarettes are not a safe alternative to traditional cigarettes as it relates to timely wound healing,’

‘Providers, and patients, need to understand the risks of both types of smoking so they can make the best decision to keep the patient as safe as possible before and after surgery.’

In experiments on rats, Dr Spiegel and colleagues found vaping affected skin wound healing, causing damage similar to that of conventional smoking.

Both forms resulted in more of the tissue dying, which delays wound healing. They said the same would apply to humans.

It follows a warning by other American experts two years ago that nicotine in e-cigarette vapor increases the risk of blood flow-related complications – just like smoking real ones.

The study, published in JAMA Facial Plastic Surgery, is the first direct evidence that they were correct.

Dr Spiegel said the adverse effects of traditional cigarette smoking on wound healing has been well established in the surgical field.

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Surgeons recommend patients quit smoking for several months prior to surgery, whenever possible.

But vaping is gaining popularity and there has not yet been significant research done about whether it is a safer alternative – particularly before an operation.

So the researchers exposed rats to traditional cigarette smoke, e-cig vapor or neither, checking for levels of a nicotine causing chemical cotinine in the blood to ensure comparable amounts.

They then created skin flaps created from the animals, which were grafted back onto each individually to measure viability and wound healing.

After two weeks, there was a statistically increased rate of tissue death on grafted flaps in groups exposed to traditional cigarettes – or e-cigs.

Dr Spiegel said they were inspired by a call from the US Food and Drug Administration for more research on the safety of e-cigs.

He said: ‘Vaping is gaining popularity among youth, first-time, and current smokers; however, evidence of its safety, particularly its association with wound healing, is inadequate.’

Studies suggest e-cig fluids contain more cancer causing chemicals, such as formaldehyde. Others show vaping pens can release heavy metals, chemicals and glass particles found in the welding material and tubing for the device.

Manufacturers of e-cigs have not published a complete list of compounds that make up the various fluids.

Dr Spiegel said: ‘The unfavorable association of traditional cigarette smoking with wound healing and flap viability has been well documented.

‘However, the literature on how e cigarettes affect wound healing and flap viability is lacking.’

He added: ‘Smoking and vaping appear to be equally detrimental to wound healing and to be associated with a statistically significant increase in tissue death.

‘The results suggest vaping should not be seen as a better alternative to cigarette smoking in the context of wound healing.

‘Surgeons are advised to appropriately counsel their patients and to regard those who use e-cigarettes as having equivalent pre-operative healing risk as those who smoke cigarettes.’

Shaun Desai, a plastic surgeon at Johns Hopkins University, Baltimore, Maryland, welcomed the findings and said patients should be screened for e-cig use before surgery.

He said: ‘This study presents evidence of the detrimental potency of e-cigarettes in rats, but there is a paucity of clinical evidence in humans.

‘Often, patients may not volunteer this information, mistakenly thinking vaping, because it is not smoking traditional cigarettes, is not relevant medical history that needs to be shared.

‘Similarly, until further studies are completed, all e-cigarette use should be stopped four weeks prior to any surgical procedure, as recommended by the current literature for traditional cigarettes.’ 

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