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Smoking - how it impacts healing and claims outcomes

By Adam Shelverton
Senior Rehabilitation Consultant

How smoking impacts healing and recovery

Bone Growth

Smoking and nicotine in particular has a direct and detrimental effect on the health of bone and its ability to heal. Nicotine causes osteoblasts (the cells that make bone tissue) to function more slowly, impacting the growth of new bone. As a consequence, this leads to fractures in smokers taking longer to heal and being weaker than non-smokers.

The more severe the fracture, the greater the potential difference in healing times can be. The incidence of fractures part healing or not uniting (mal-union) is significantly higher with smokers. Orthopaedic consultants often advise people who are scheduled for surgery such as joint replacements to stop smoking to improve their recovery rates and reduce the risk of infection.

Wound healing is impacted by smoking as nicotine causes vasoconstriction (narrowing of blood vessels) and inhibits the function of red blood cells, which in turn negatively affects wound healing. Narrowing of blood vessels causes a reduction in the capability of red blood cells to transport oxygen, slowing down healing further.


Nicotine also has a negative effect on our white blood cells, essential for fighting infection within the body, which is particularly important if you have undergone surgery or have suffered an open fracture (Where the fracture breaks the skin – sorry for the squeamish amongst you). A reduced effectiveness of white blood cells slows healing further and increases your risk of infection.

It is generally accepted that the more you smoke, the greater the impacts on bone growth and the risk of infection are.

Impact on claims and return to work outcomes

Claims adjusters and employers should be conscious of the negative impacts of smoking on recovery, especially if the individual has other notable risk factors such as diabetes or obesity. The risk that these individuals will suffer from delayed healing is high, which leads to greater sickness absence and more expensive claims due to, for example, increased loss of earnings.

How can slow healing be prevented?

Fortunately, healing is an automatic process that requires no conscious effort or thought and in the majority of cases completes without any problems or issues. That said there are some things we can do to ensure healing and recovery rates are optimised.

1) Stop smoking: Giving up smoking drastically improves healing rates.

2) Nutrition: Protein, vitamin C, vitamin A and zinc are all important and need to be at the right levels to provide the optimum environment for effective healing. You may have seen the exercise fanatics around the office drinking a protein smoothie after exercise. This is because protein is particularly important in muscle recovery.

3) Oxygen: Oxygen is absolutely essential to cell recovery and growth. Typically most of us have an oxygen blood level content of 98%+ and do not need to worry.  However, if we have received an anaesthetic we may require supplementary oxygen to facilitate healing. Anaesthetic and in particular general anaesthetic temporarily reduces our lungs ability to transport oxygen around our body, which is why, post surgery, everyone receives additional  oxygen help them recover and heal as quicky as possible.

Smokers have lower blood oxygen content for two reasons: Firstly they have lower lung capacity meaning they inhale and exhale less air than a non-smoker because their lung tissues have been damaged. Secondly, because the carbon monoxide in cigarette smoke combines with haemoglobin inthe blood and as a consequence prevents Oxygen molecules combining with it. These both increase the risk of bronchitis, pneumonia and upper respiratory tract infections.

4) High blood sugar: High blood sugar levels also negatively impact cell healing. Diabetics in particular should keep a close eye on their blood sugar levels to prevent complications associated with healing and infection.

Your contact

Your contact

Adam Shelverton

Adam Shelverton

Rehabilitation Manager

Tel: +44 (113) 2906321