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PRACTICE
MANAGEMENT
No Smoking: Why Many Physicians Refuse to Operate on Smokers
— 8 Takeaways
By Adam Schrag
P
hysicians are turning smokers away
with increasing regularity, accord-
ing to The Charlotte Observer.
As research continues to shed light on
the impact a patient's lifestyle has on a
surgery's outcome and physicians' sal-
aries, physicians are putting their foot
down and starting a bold trend.
Here are eight things to know:
1. In addition to linking smoking to heart
disease and cancer, recent research has
proven that smoking stalls wound heal-
ing by disrupting blood flow.
2. A 2016 study published in Global
Spine Journal revealed that non smokers
recover much better after spinal fusion
surgery and joint replacements than
smokers.
3. Smokers who undergo joint replace-
ment surgery have an 80 percent higher
chance of needing repeat surgery be-
cause of infections and complications.
4. Physicians are requesting that pa-
tients quit smoking or stop for specified
periods of time before and after surgery
on an increasingly frequent basis.
5. These recent developments have
led to "surgical optimization," which
is the physicians' term for making
sure patients are as healthy as possi-
ble going into surgery. Patients with
obesity or diabetes fall under a similar
category and are often referred to nu-
trition counseling and other forms of
treatment to improve chances of the
surgery's success.
6. Bryan Edwards, MD, head of ortho-
pedic surgery at Charlotte, N.C.-based
Novant Health said, "If you're doing
surgery, you're trying to get the bones
to unite, and if you don't have good
blood flow, the results aren't as good."
7. Surgical complications stemming
from smoking, diabetes or obesity
impact physicians' pay, and could po-
tentially impact a surgeon's decision
to use a fee-for-service system or a
value-based system with a single bun-
dled payment per patient encounter.
8. Leo Spector, MD, a spine surgery
specialist at Charlotte, N.C.-based Or-
thoCarolina said, "A year from now, I'll
probably be at a point where I would
require all my patients to stop smok-
ing… Currently, I evaluate it on a case-
by-case basis. Over time, we're going
to feel comfortable being a little more
stringent with our patients about these
modifiable risks." n
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