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Elective Surgery Ban for Smokers and Obese Patients

Monday, November 27, 2017

Submitted by


Source Name: MedPage Today


Skeptical Scalpel

The medical care oversight committee for Hertfordshire County, England, has banned elective surgery for the obese and for those who are actively smoking. Obese patients must lose 10% to 15% of their body weight within 9 months to qualify, and smokers must abstain for at least 8 weeks if elective surgery is to be performed. Free counseling to achieve these goals is provided.


Are they making patients who need a curative cancer operation wait 8 weeks during which time the tumor might upstage and become incurable or require morbid adjuvant therapy? This would be unconscionable. It is a dirty little secret in the U.S. that many thoracic surgeons deny smokers potentially curative pulmonary resection and that thoracic surgical leaders duck discussion or confrontation on this issue. Most smokers begin using this lethal product before they reach the "age of reason" and succumb to a powerful addiction. A large majority of quit attempts using best practices fail. It is wrong to deny surgery for such people. There might be more of a case to insist that smokers quit before elective surgery e.g. face lifts where healing problems secondary to smoking may compromise excellent results.
The article doesn't discuss or define "elective" surgery. I think most lay people would hold the opinion that cancer surgery is not elective, even though it doesn't meet that definition from a strictly medical perspective. Interestingly, the article states that variations of that county's policy have been in effect in many areas of England for a while. This particular policy is notable in that it doesn't offer patients a way out if they fail to achieve compliance with weight loss/smoking cessation.

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