Are electronic cigarettes and vaping effective tools for smoking cessation? Limited evidence on surgical outcomes: a narrative review

Abstract

The rising popularity of e-cigarettes and vaping, particularly in youth populations, has prompted the scientific community to ocassionally recommend their use as alternative to smoking or as a modality for smoking cessation. Media also tends to portray them as stylish, smoking cessation tools. We first studied the current literature to better understand whether they are viable options for surgeons to use prior to surgery as part of their armamentarium and their efficacy in attaining smoking abstinence. Next, we performed a comprehensive review of the literature to study the impact of e-cigarette and vaping on lung pathophysiology, surgical outcomes, and postoperative complications. After a thorough search, we found limited evidence suggesting that e-cigarettes and vaping are effective smoking cessation tools, and indeed may increase the propensity of dual smoking, contrary to e-cigarette advertisements. Many potential biases and limitations exist due to self-reporting when investigating e-cigarettes and vaping. While there is controversial data in the literature about e-cigarettes and vaping not leading to lung cancer, there are chemicals in these products that compromise lung hemostasis, negatively affect the immune system, and have detrimental inflammatory effects on wound healing. Studies are warranted to elucidate objective data regarding short and long-term effects of these products on surgical outcomes, and given the current data, they should not be utilized as viable smoking cessation tools.

Smoking increases the risk of postoperative wound complications: A propensity score‐matched cohort study

“…A case report by Fracol et al described an e‐cigarette user who had significant mastectomy skin flap necrosis after a bilateral mastectomy 34 . Despite insufficient evidence, data suggest that e‐cigarettes may have a significant adverse effect on wound healing 50‐52 . Further investigations are needed to validate the effects of e‐cigarettes on perioperative outcomes.…”

“… 34 Despite insufficient evidence, data suggest that e‐cigarettes may have a significant adverse effect on wound healing. 50 , 51 , 52 Further investigations are needed to validate the effects of e‐cigarettes on perioperative outcomes.…”

Vaping and perspectives in colorectal surgery: A call for action

“…Preliminary data from animal models and case reports suggest a detrimental effect of ENDS on skin flap survival comparable to that of traditional tobacco smoking, but these findings are limited in terms of sample size and quality [4,[17][18][19][20].…”

Anesthesiologists and the Other Pandemic: Tobacco Use

“…82,83 There are no data in patients save two case reports of problems with flaps in vapers that do not provide a convincing link. [84][85][86] Thus, even if vapor may prove "safer" than cigarette smoke in some respects, it is not "safe." 54 effect of Surgery on tobacco Use…”