Smokers have an elevated risk of perioperative respiratory distress and of transfer to intensive care. Tobacco smoke substantially alters the healing process and constitutes a documented risk factor for postoperative complications (anastomotic leakage, delayed healing etc.). Risk of postoperative infection is also higher in smokers. When patients stop smoking 6 to 8 weeks before surgery, the incidence of complications related to tobacco smoke drops nearly to zero. Even stopping for a short period reduces the risk of complications, although the benefits of stopping increase with length of time. Preoperative smoking cessation should take place as early as possible. The general practitioner and the surgeon both have essential roles to play. Identification of smokers must be accompanied by measures to help the patient stop smoking, including advice, and if necessary, nicotine substitutes. Anxiety levels are higher in smokers than nonsmokers. Nonetheless smoking cessation for hospitalization does not increase these levels, even without nicotine substitutes. There is no interaction between anesthetic agents and nicotine substitutes: the latter may be continued through the morning of surgery and reinitiated in the immediate postoperative period. Patients who stop smoking for surgery should be encouraged to continue to stop, permanently. The general practitioner's support is essential for this.