Background Postoperative pain (POP) and postoperative nausea and vomiting (PONV) are frequent and distressing complications after surgery. Smoking has been proposed as a modifiable factor influencing these outcomes, yet evidence is inconsistent and scarce from low- and middle-income countries (LMICs). We examined whether current smoking status independently predicts early POP and PONV. Methods We conducted a prospective, observational study in two West Bank of Palestine tertiary referral hospitals over six months. Adults (≥18 years) undergoing elective surgery under general anaesthesia were included. Smoking status was self-reported (current smoker vs. nonsmoker). End-points 24 h after surgery were nausea (presence and severity on VAS), vomiting (number of episodes), and pain (presence and severity on VAS) were investigated. Logistic regression was employed to estimate adjusted odds ratios (aORs) for associations of smoking status with each outcome after adjustment for age, sex, height, weight, history of previous surgeries, history of PONV, surgical approach, duration of anaesthesia, and intraoperative opioid/antiemetic use. Results Among 200 patients (90 smokers; 110 nonsmokers; median age 38 years), crude rates were: nausea 32.5% (nonsmokers 37.2% vs. smokers 26.6%), vomiting 23.1% (28.4% vs. 16.6%), and pain 87.9% (91.7% vs. 83.3%). After adjustment, smoking status was not significantly associated with postoperative nausea (aOR 1.57; 95% CI 0.64–3.86), vomiting (aOR 1.13; 95% CI 0.45–2.85), pain (aOR 0.98; 95% CI 0.29–3.23), or their severities (all p>0.05). Conclusion For this two-centre LMIC cohort study, current smoking status was not an independent predictor of early POP or PONV. Perioperative risk stratification and prevention should not solely be based on smoking status but include validated predictors (e.g., sex, history of PONV, type of procedure, duration of anaesthesia, opioid exposure). Well-powered standardised multicentre studies quantifying smoking exposure (e.g., pack-years, duration since cessation) are required. Keywords Smoking, Postoperative pain (POP), Postoperative nausea and vomiting (PONV), General anaesthesia, Elective surgery, Risk factors, Surgical patients

Title

Perioperative Medicine

Publisher

Springer

Publisher Country

Germany

Indexing

Scopus

Impact Factor

None

Publication Type

Prtinted only

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Year

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Pages

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