Kuwait opened the region’s first smoking cessation clinics in the 1980s, and the strongest evidence for what they do sits in the weeks before an operation.
A wound that looks closed is not the same as a wound that has healed. That distinction is the basis of a message Dr Khaled Al-Tarrah, a Kuwaiti plastic, reconstructive and aesthetic surgeon working under the Ministry of Health, has been putting directly to patients who already have an operation booked.
“A wound may look closed… but healing is not complete,” he wrote in a recent post. “Smoking raises the risk of wound opening, infection and delayed healing. Quitting 4–6 weeks before surgery and staying smoke-free for 4 weeks after may reduce wound complications by 50%.” A companion post gives patients the mechanism in a line: smoking or shisha reduces oxygen delivery to a healing wound, and one decision can support a better recovery.
The evidence behind the number
The figure is not rhetorical. The American College of Surgeons gives surgical patients the same window and the same estimate, telling them that quitting four to six weeks before an operation and staying smoke-free for four weeks afterwards can cut their rate of wound complications by half.
A joint study by the World Health Organization, the University of Newcastle in Australia and the World Federation of Societies of Anaesthesiologists, published in January 2020, arrived at a compatible conclusion from a different direction. Smokers who quit roughly four weeks or more before surgery face a lower risk of complications and better results six months on, and every tobacco-free week beyond four improves outcomes by about 19 percent, an effect the study attributes to improved blood flow to organs and tissue. Nicotine and carbon monoxide lower oxygen levels, which is the same physiology Al-Tarrah describes when he talks about oxygen reaching a healing wound.
Why the window matters more each year
The relevance to Kuwait is a matter of arithmetic. The Ministry of Health’s WHO-supported national STEPS survey, analysed in Environmental Science and Pollution Research, put current smoking among Kuwaiti adults at 39.2 percent of men and 3.3 percent of women, with an average age at initiation of 17.5 years. Those are the patients who present for hernia repair, joint replacement, burns reconstruction and elective aesthetic surgery.
Surgical activity is moving with them. An analysis of ministry annual reports published in Frontiers in Health Services in July 2026 recorded a 12 percent rise in the ministry’s top 100 surgeries among Kuwaiti patients between 2011 and 2022, alongside growth in hospital beds from 6,703 to 8,735 and in general and specialised hospitals from 14 to 20. More capacity means more elective operations, and every elective operation carries a date that can be worked backwards from.
The head start
Kuwait is unusually well placed to act on that. According to WHO’s Eastern Mediterranean regional office, Kuwait was the first country in the region to establish cessation clinics, with the first operating since the early 1980s. A 2003 ministerial decree put a clinic in every governorate, six in total, plus one serving oil industry workers at Shuaiba. Services are free and include medical assessment, nicotine replacement therapy and counselling, with six-month cessation success rates averaging around 30 percent.
Measured against the region, that is a strong position. A WHO review of cessation services across the Eastern Mediterranean found that while nearly 70 percent of people in the region have legal access to nicotine replacement therapy, the cost is not covered for 77 percent of them, and just under half have access to any cessation support in primary care. Kuwait’s clinics are free, protocol-driven and already staffed.
The limit worth stating
The evidence does cut against quick fixes. The Cochrane review of preoperative smoking cessation found that brief advice close to the operation date is likely to have only a small effect on smoking behaviour and has not been shown to reduce complications. What works is intensive support begun four to eight weeks out, with weekly counselling and nicotine replacement. A 2025 systematic review in Perioperative Medicine notes the practical obstacle facing every health system: the interval between a pre-operative appointment and surgery is often too short to fit four weeks of sessions.
Which is precisely why the timing, not the message, is the whole intervention. Al-Tarrah’s posts push the conversation upstream, to the point on the calendar where the published evidence says the benefit actually sits.
