Most people know that smoking is linked to heart disease and cancer. But in recent years, research has shown that smoking also inhibits wound healing because it decreases blood flow.

As a result, smokers don’t do as well as nonsmokers after having spinal fusion surgery and joint replacements. One study found that smokers undergoing joint replacement surgery had an 80 percent higher chance than nonsmokers of needing repeat surgery because of complications from infection. For this reason, surgeons have begun asking these patients to quit smoking — or at least stop for four to six months before and after surgery.

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“We want the best results possible,” said Dr. Bryan Edwards, head of orthopedic surgery for Novant Health. “We’re not denying you a surgery. We’re preventing you from having a complication.

“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,” Edwards said. “I tell patients, ‘Complications from surgery are far worse than whatever condition you have now. If you’ve got an infected back that doesn’t fuse, you don’t want that.’ ”