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We read with interest the edition of SAMJ (November 2013) dedicated to smoking, arguably the most significant modifiable cause of death and disease. One of the areas not addressed relates to the impact of smoking in the context of surgery. It is well recognised that smoking increases the risk of overall complications, arrhythmias, thrombotic episodes, pneumonia, infection, wound healing complications and prolonged hospital stays, as well as the need for further surgery. As surgeons we are frequently held responsible for these complications, and yet the decision to undertake the procedure at all should often be scrutinised, especially in the elective setting, rather than just the technical execution thereof.

Reducing the surgical complications of smoking by cotinine testing