Aim and Background: It is estimated that up to 20% of patients coming for elective surgery are smokers and carry a risk of perioperative complications. Though smoking cessation and its impact on perioperative outcome are widely investigated worldwide we were unable to find any data in Pakistan. The objective of the study is to determine the impact of the duration of smoking cessation before elective surgery on intraoperative hemodynamics and postoperative pain in Pakistani population. Methods: It was a prospective cohort study conducted at the Aga Khan University Hospital Karachi, Pakistan, for one-year duration. A total of 260 patients scheduled for elective noncardiac surgery under general anaesthesia were recruited. Surgery under regional anaesthesia and minor surgery under general anaesthesia were excluded. Data on self-reported duration of smoking cessation by patients, intraoperative haemodynamics, postoperative pain scores and duration of hospital stay were collected by independently trained data collectors from the preoperative area until the patient is discharged from the hospital. Results: A data from 256 patients were analyzed. On the basis of self-reported duration of preoperative smoking cessation, patients were divided into 4 groups (Group 1: less than 2 days, Group 2: more than 2 days to 7 days, Group 3: more than 7 days to 4 weeks and Group 4: more than 4 weeks). It was found that the longer the duration of cessation of smoking is the less haemodynamic changes and lower postoperative pain scores. Length of stay did not show any difference among all four groups. No major postoperative pulmonary complication was found in any study patient. Conclusions: Duration of cessation of smoking before elective surgery is a significant predictor of intraoperative haemodynamics and early postoperative pain in Pakistani population. A short duration of smoking cessation also helps to avoid some of the adverse effects and reduces perioperative complications
