Smoking Behavior and Perceived Stress in Cigarette Smokers Undergoing Elective Surgery

David O. Warner, Christi A. Patten, Steven C. Ames, Kenneth Offord, Darrell Schroeder

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


Background: The forced abstinence from cigarettes accompanying surgery in smoke-free facilities may increase psychological stress by removing a coping mechanism and by nicotine withdrawal. The authors tested the hypothesis that abstinence from cigarette smoking contributes to psychological stress in the perioperative period. Methods: The authors assessed measures of nicotine withdrawal (Hughes-Hatsukami nicotine withdrawal scale) and perceived stress (including the Perceived Stress Scale) in 141 cigarette smokers scheduled to undergo elective surgery. To separate the effects of stress arising from tobacco abstinence from the effects of other perioperative stressors, such as pain, these measures were also obtained in 150 surgical patients who did not use tobacco. Assessments were performed at intervals beginning at the time of preoperative medical evaluation and ending 30 days postoperatively. Results: Perceived Stress Scale scores were significantly (P < 0.001) higher in smokers throughout the study period. There was little significant interaction between smoking status and time, indicating that changes in Perceived Stress Scale score during the perioperative period did not differ between smokers and nonsmokers. The same result was found if analysis was restricted to data collected before hospital discharge (and thus during assured abstinence). Similar results were found for the nicotine withdrawal scale, suggesting that smokers did not experience more withdrawal symptoms relative to nonsmokers. Conclusions: Although smokers report increased baseline stress, smoking status does not affect changes in perceived stress over the perioperative period. Nicotine withdrawal symptoms do not seem to be a clinically significant problem in the perioperative period for most smokers.

Original languageEnglish (US)
Pages (from-to)1125-1137
Number of pages13
Issue number5
StatePublished - May 2004

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Smoking Behavior and Perceived Stress in Cigarette Smokers Undergoing Elective Surgery'. Together they form a unique fingerprint.

Cite this