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Being told you need surgery can elicit a range of reactions. Some people may go for a long walk, look up the procedure on the Internet or talk with an old friend. For those who smoke, taking a soothing drag off a cigarette can seem as good a comfort as any.

That's precisely what a group of doctors in Ontario is bent on changing.

Patients who smoke in the six to eight weeks leading up to surgery can have a much longer recovery time and face a higher risk of complications, such as infection and respiratory problems, than those who don't, according to Ontario's Anesthesiologists, a group that operates under the umbrella of the Ontario Medical Association. They want surgeons and other health professionals to talk to patients about the risks of smoking before surgery, and have developed an action plan they're urging hospitals to adopt as a way of systematically ensuring patients have access to cessation treatment and support.

“It needs to be a concerted effort,” said John Oyston, chief of anesthesiology at Scarborough Hospital in Toronto and founder of the Stop Smoking for Safer Surgery campaign. “Surgeons need to know. They need to start getting the message out.”

The message is for patients to not only stay away from cigarettes for six to eight weeks before surgery but to continue to avoid smoking during recovery.

Dr. Oyston recognizes that not smoking for weeks on end may be impossible for some patients. Some people may not even have six weeks notice they need surgery, he said. So at the very least, he urges patients to keep away from cigarettes the entire day before they're due to have surgery and at least one week after.

Although the risks of smoking are well-known to smokers and non-smokers alike, those risks take on a new significance when a patient faces a major medical procedure. Smoking can inhibit the body's ability to heal itself after surgery, and can also cause a range of breathing problems or other respiratory issues. Numerous medical studies have shown that people who smoke in the lead-up to surgery have longer hospital stays than those who don't smoke and are sometimes even re-admitted after being discharged.

A Swedish study published in the March issue of the journal Anaesthesia found that patients who took part in a formal smoking cessation program before and after surgery had half as many complications than those smokers who didn't receive help quitting. The study found that only one smoker in the group that received no formal smoking cessation help was able to quit in the period leading up to surgery and during recovery.

Smoking can lead to complications and other problems related to surgery in a variety of ways. Dr. Oyston said one of the most obvious health effects is wheezing and other breathing problems that can be brought on or exacerbated by surgery. Problems can be so severe that patients may end up in an intensive-care unit, he said. Smoking also increases the level of carbon monoxide in the body, which can stop red blood cells from carrying oxygen to tissues and around the body, impeding recovery. The lack of oxygen can also increase the likelihood a patient will experience cardiac distress, Dr. Oyston said.

Despite the benefits of going into surgery smoke-free, Dr. Oyston said some health professionals don't communicate the gravity of risks to patients.

But even if they do, many smokers have an extremely difficult time giving up cigarettes for a few days, let alone weeks, said Veda Peters, tobacco education co-ordinator with the B.C. Lung Association. “It's not that they don't know it's dangerous, they do. But the addiction is more than just that physical dependency on nicotine. It's the ritual,” she said.

In many cases, being told they need to quit in preparation for surgery won't be enough. Smokers will need access to therapies that can help them quit, or at least abstain from smoking before and after their hospital stay, Ms. Peters said.

Dr. Oyston and his colleagues involved in the campaign want doctors and other health professionals to routinely ask people who are scheduled to undergo surgery if they smoke. If they do, the anesthesiologists want patients to be referred to free resources, such as smoking cessation help lines to help them give up cigarettes, at least on a temporary basis. Once surgery is complete, doctors should follow up with patients to encourage them to avoid smoking during recovery.

“If we can bring all those things together then we can make a real difference,” he said.

The short-term goals are clear: quicker recovery times and reduced chance of complications. But those patients who follow medical advice and give up cigarettes in preparation for surgery could also find they never go back to their old habit.

“That's the big challenge,” Dr. Oyston said.