Smoking is responsible for diseases that may require surgery, but regardless of the reason for the procedure, tobacco smoke is responsible for a significant increase in perioperative complications. Even outside of any surgical period, smoking more than doubles the risk of numerous infections such as pneumococcal pneumonia, Legionnaires’ disease, pulmonary tuberculosis, secondary infections in COPD, or bacterial meningitis, including in children exposed only passively to tobacco smoke. For over 60 years, it has been known that tobacco smoke causes general complications during the perioperative period, particularly respiratory complications. More recently, an increased risk of surgical site complications linked to smoking has been demonstrated. [...] On October 17, 2005, the conclusions of the first expert conference on perioperative smoking, organized jointly by anesthesiologists from the French Society of Anesthesia and Intensive Care (SFAR), surgeons from the French Association of Surgery (AFC), and tobacco specialists from the French Office for Tobacco Prevention (OFT). For this conference, the organizing committee defined the methodology and research questions; six groups of three to five experts then analyzed the literature using a specific methodology, drafted a report, and submitted their findings to the organizing committee. A first draft of the recommendations was submitted for consensus-building among all experts using the Delphi method; subsequently, three meetings of the expert committee led to a consensus on a text to be submitted for public debate at the SFAR congress. The final text, approved by the organizing committee, was released in November 2005. The experts’ papers are currently being published. This expert conference made it possible to estimate the number of smokers undergoing surgery, to summarize the consequences of perioperative smoking and the benefits of quitting, and finally to propose a framework for care management aimed at changing practices and improving health. (Excerpt from the introduction)