Smoking remains a prevalent part of present day society, with over 42 million Americans who continue to use cigarettes. Smoking is strongly associated with a variety of conditions that result in increased morbidity and mortality. Research also indicates that smoking has an adverse effect on surgical outcomes. Its effect on the musculoskeletal system is evident and results in postoperative complications such as infection, nonunion, and malunion. These complications also come with a price, as there are severe economic implications of smoking. Patients who smoke may benefit from a period of perioperative cessation to help diminish some of these negative outcomes. It is the physician's duty to educate patients preoperatively about these outcomes and the potential benefit of smoking cessation.