title: Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery.
abstract: BACKGROUND
  The forced abstinence from cigarettes accompanying surgery in smoke-free facilities may increase psychological stress by removing a coping mechanism and by nicotine withdrawal. The authors tested the hypothesis that abstinence from cigarette smoking contributes to psychological stress in the perioperative period.
  
  
  METHODS
  The authors assessed measures of nicotine withdrawal (Hughes-Hatsukami nicotine withdrawal scale) and perceived stress (including the Perceived Stress Scale) in 141 cigarette smokers scheduled to undergo elective surgery. To separate the effects of stress arising from tobacco abstinence from the effects of other perioperative stressors, such as pain, these measures were also obtained in 150 surgical patients who did not use tobacco. Assessments were performed at intervals beginning at the time of preoperative medical evaluation and ending 30 days postoperatively.
  
  
  RESULTS
  Perceived Stress Scale scores were significantly (P < 0.001) higher in smokers throughout the study period. There was little significant interaction between smoking status and time, indicating that changes in Perceived Stress Scale score during the perioperative period did not differ between smokers and nonsmokers. The same result was found if analysis was restricted to data collected before hospital discharge (and thus during assured abstinence). Similar results were found for the nicotine withdrawal scale, suggesting that smokers did not experience more withdrawal symptoms relative to nonsmokers.
  
  
  CONCLUSIONS
  Although smokers report increased baseline stress, smoking status does not affect changes in perceived stress over the perioperative period. Nicotine withdrawal symptoms do not seem to be a clinically significant problem in the perioperative period for most smokers.
authors.affiliation: Department of Anesthesiology, the Anesthesia Clinical Research Unit, and the Nicotine Research Center, Mayo Clinic, Rochester, Minnesota, USA. warner.david@mayo.edu
authors.forename: David O
authors.initials: DO
authors.lastname: Warner
authors.forename: Christi A
authors.initials: CA
authors.lastname: Patten
authors.forename: Steven C
authors.initials: SC
authors.lastname: Ames
authors.forename: Kenneth
authors.initials: K
authors.lastname: Offord
authors.forename: Darrell
authors.initials: D
authors.lastname: Schroeder
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010465:Perception; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology* / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000523:psychology