Background The dangers of tobacco is one of the most serious public health problem in the world today. Some 69 million adults receive operations every year, and millions of them encounter perioperative respiratory and cardiovascular complications.Objective This article reviewed the effects of smoking on the surgical outcomes in patients and its mechanism. Content During perioperative period smoking patients encounter with pneumonia, non-expected endotracheal intubation, mechanical ventilation, cardiac arrest, myocardial infarction, stroke, superficial or deep cut infection, sepsis, organ cavity infection and septic shock, postoperative opioid requirements increase. Trend Study on the mechanisms of influence of smoking on perioperative complications and pain sensitivity provide theoretical basis for the rehabilitation of surgical patients.