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

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.