Smoking increases the risk for serious complications after major surgery, but former smokers who stop at least a year before going under the knife had risks close to those of never-smokers, according to a new study.

Current smokers in the study had higher risk for heart attack, blood clots, pneumonia, and even death post-surgery compared to people who had never smoked and those who had stopped smoking.

“The adverse long-term effects of smoking are well known, but to have such effects in an acute setting like surgery had not been well elucidated,” according to senior author Dr. Faek Jamali of the American University of Beirut Medical Center in Lebanon.

These results add to the spectrum of the damaging effects of smoking, Jamali told Reuters Health by email.

Using the American College of Surgeons database, he and his colleagues examined smoking history, risk factors and complications 30 days post-surgery for 125,000 current smokers, 78,000 former smokers who had quit at least a year earlier and 400,000 people who had never smoked.

The researchers looked for events like heart attack, blood clots, pneumonia, and death.

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