Heated Tobacco Products as a Harm Reduction Strategy in Surgical Patients: Safer Than Smoking?

Jeffrey Ariesta Putra; Dianita Angeline

Authors

Jeffrey Ariesta Putra Universitas Negeri Yogyakarta, Yogyakarta, Indonesia Author
Dianita Angeline Universitas Negeri Yogyakarta, Yogyakarta, Indonesia Author

Keywords:

Heated tobacco products, wound healing, surgery, smoking cessation, harm reduction, perioperative risk

Abstract

Background: Tobacco smoking is a well-established modifiable risk factor for poor postoperative outcomes, including delayed wound healing, increased infection risk, and cardiopulmonary complications. In Indonesia, smoking prevalence remains high among surgical patients, while access to and compliance with preoperative cessation interventions is limited. Heated tobacco products (HTPs), which deliver nicotine by heating rather than combusting tobacco, have emerged as a potential harm reduction alternative. However, their role and safety in surgical populations remain uncertain.

Objective: This review aims to evaluate the current evidence comparing the biological and clinical effects of HTPs versus conventional cigarettes in the context of wound healing and perioperative complications, with a focus on their potential use as a harm reduction strategy in surgical patients.

Methods: A narrative review methodology was employed. Literature was searched across PubMed, Scopus, and grey literature sources from 2010 to 2025. Inclusion criteria encompassed clinical and preclinical studies reporting on toxicological profiles, tissue oxygenation, immune function, wound healing, and perioperative complications associated with HTPs and combustible tobacco products. Data were extracted and thematically synthesized.

Results: HTPs eliminate combustion, leading to markedly reduced emissions of tar, carbon monoxide, and other harmful byproducts. These changes may mitigate mechanisms contributing to surgical complications, including vasoconstriction, hypoxia, immune suppression, and impaired collagen synthesis. However, HTP aerosols still contain nicotine, volatile organic compounds, and heavy metals, which can continue to interfere with wound healing. Comparative evidence suggests HTPs pose a lower biological risk than smoking, but their use is not without harm.

Conclusion: HTPs may offer a transitional harm reduction option for surgical patients unable to achieve smoking cessation. However, they are not risk-free and should not replace cessation as the standard of care. Further research, including human clinical trials, is needed to evaluate the safety and efficacy of HTPs in surgical contexts.

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