In April’s issue of Anesthesiology
, using the National Surgical Quality Improvement Program database, Turan et al.
demonstrate that smokers have a higher incidence of morbidity and mortality than non-smokers. As noted in Katznelson and Beattie’s accompanying editorial
, the key issue is whether a smoker can reduce this risk by cessation of smoking prior to surgery. He makes a great argument that Turan’s study
adds ammunition to the anesthesiologist’s arsenal to convince a patient (and the surgeon) that quitting smoking prior to elective surgery should be done.
But Turan’s study
is neither the first nor the last to show that smoking is bad for you. Hence, we often collectively scratch our heads and wonder why people still do it. Further, why don’t they quit before surgery?
I don’t want to talk about addiction to nicotine or the societal pressures that may stop a patient from quitting. On the other hand, I often wonder how we, as humans, view risk.
At the end of my preoperative discussion with parents about their child’s anesthesia care, I say, “I can’t promise nothing bad ever happens, but I am more worried about driving to work than something bad happening to your child as a result of anesthesia. I think your child will do well.” I then go on to reemphasize other things that are likely more potentially harmful than anesthesia. I remind them that if they are worried about the anesthesia, then they should not text or talk on the phone while driving, they should always use car seats (or booster seats and/or seat belts depending on the child’s age), that their child should wear a helmet when he/she gets a bike or scooter, and they should definitely be more worried about the next birthday party their child attends involving a moonwalk since kids are wont to bounce into each other. I finally say that if they have a trampoline, then they ought not to worry about anesthesia.
In other words, I try to point out the relative safety of anesthesia compared to various risks we encounter in our daily lives.
But why aren’t we concerned about these other risks?
To get a glimpse into the answer to this complex question, I suggest you read David Ropeik’s November 26, 2006 article in Time, How Americans are Living Dangerously
At the same time, 20% of all adults still smoke; nearly 20% of drivers and more than 30% of backseat passengers don't use seat belts; two-thirds of us are overweight or obese. We dash across the street against the light and build our homes in hurricane-prone areas--and when they're demolished by a storm, we rebuild in the same spot. Sensible calculation of real-world risks is a multidimensional math problem that sometimes seems entirely beyond us. And while it may be true that it's something we'll never do exceptionally well, it's almost certainly something we can learn to do better.
In the meantime, I’m going to head to the gym, continue eating better and dieting, take my hypertension and hyperlipidemia medication, wear my seat belt, and not text while driving. Thankfully I don’t smoke.
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Posted by Amr Abouleish MD, MBA