Purpose： Using the colon cancer surgery as a model, we aimed to elucidate the effects of perioperative smoking on medical costs during this period.
Methods： Subjects were 89 patients who underwent elective radical surgery of laparotomy for colon cancer in our department from 1st January 2011 to 31st December 2012. Subjects were initially divided into smoker and never-smoker groups. The smokers were further divided into three sub-groups according to their smoking status from the time of their first visit to this department to before surgery: ex-smokers (those who stopped smoking long before the surgery), recent non-smokers (those who stopped smoking shortly before the surgery as recommended by their doctor) and current smokers (those who continued smoking). We compared the differences in medical costs during the perioperative period among the groups and subgroups. Our hospital follows the Diagnosis Procedure Combination/Per-Diem Payment System (DPC/PDPS), a flat-rate payment system, for medical costs. Medical costs were compared by examining the piecework points, comprehensive points and gross pay points calculated using the DPC/PDPS.
Results： Compared with the never-smoker group, medical costs were significantly high in the smoker group in terms of the comprehensive points and gross pay points (p = 0.0375 and 0.0398, respectively). Furthermore, the medical costs of the current smoker group were significantly higher than those of the exsmoker and recent non-smoker groups.
Conclusion ： We found that perioperative smoking significantly increases medical costs during the perioperative period of colon cancer surgery. Furthermore, our results suggested that cessation of smoking before surgery can decrease the medical costs to the same level as those in never-smokers. Therefore, we recommend active non-smoking guidance to patients prior to surgery.

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