Tobacco use and especially cigarette smoking have been linked with delayed healing and poor wound healing in study after study. Nicotine is a vasoconstrictor, which means it causes blood vessels to narrow (constrict).
Smaller blood vessels deliver less blood, oxygen, and nutrients to injuries or surgical sites. Reduced blood flow also means less clearance of toxins and cell waste products.
In a recent study at the New York Upstate Medical University, smoking was a significant predictor of pain in the first 12 months after anterior spinal fusion with cages. Emotional health was the strongest predictor of results. There may be an association between poor mental health and smoking, but this was not part of the study.