American Society of Plastic Surgeons
For Medical Professionals
David Boros
one year ago

standard of care when patient tests positive for cotinine for fat transfer to right buttock

Patient, an active smoker, tested positive for cotinine on the day of surgery for a fat transfer to her right buttock to repair an "indentation" from a prior injury. The clinic's smoking informed consent form included a paragraph that the patient was to quit smoking 6 weeks prior to the scheduled surgery date.

Is there a standard of care under these circumstances.

Procedure: Buttock Lift with Augmentation
Location: irvine, CA

Replies 4

Aaron Stone
ASPS Surgeon

4 weeks is the standard and is the answer in the in service and board examination. Longer is obviously better. Both the surgery/skin or graft viability and anesthesia recovery can be problematic in smokers.

Samir Shureih

The policy for stopping smoking prior to elective surgery is there to protect the patient and decrease the risks of complications.

Whether it four or six weeks prior to surgery and the same amount of time after surgery, the clinic policy has to be followed. if tested positive for nicotine, the surgery is cancelled.

As Board Certified Plastic Surgeons, we strive to achieve the best results and have patient safety as priority. However the patient needs to follow the preoperative and post-operative instructions to achieve the results desired and minimize risks and complications.

The informed consent, the pre-operative and post-operative instructions is a binding contract.

Rahul Vemula
ASPS Surgeon
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Thank you for your question. EVery surgeon has different criteria for safely performing an operation. Cotinine is a nicotine metabolite which shows up in the urine and blood when there is recent exposure to nicotine such smoking, vaping, using marijuana rolling papers with nicotine, nicotine gum, nicotine patches, cigars, and second hand smoke.

Exposure to nicotine compromises the microscopic blood vessels and causes increased complications such as delayed wound healing and increased surgical site infections.

I personally have patients stop 4 weeks prior to surgery and 6 weeks after surgery.

It is my policy that I test for cotinine and if positive surgery is cancelled.

Alfred Antonetti
ASPS Surgeon

You had three perfect answers from Drs. Stone, Shureih and Vemula. Those guidelines are there for a reason and it is to protect the patient.


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