Preoperative Exposure to Fine Particulate Matter and Risk of Postoperative Complications: A Single Center Observational Cohort Bayesian Analysis

Abstract

AbstractBackground & ObjectivesWhile exposure to fine particulate matter air pollution (PM2.5) is known to cause adverse health effects, its impact on postoperative outcomes in US adults remains understudied. Perioperative exposure to PM2.5may induce inflammation that insidiously interacts with the systemic inflammatory response after surgery, leading to higher postoperative complications.MethodsWe conducted a single center, retrospective cohort study using data from 64,313 surgical patients living along Utah’s Wasatch Front and undergoing elective surgical procedures at a single academic medical center from 2016-2018. Patients’ addresses were geocoded and linked to daily Census-tract level PM2.5estimates preoperatively. We hypothesized that elevated PM2.5concentrations in the seven days prior to surgery would be associated with an increase in a bundle of major postoperative complications. A hierarchical Bayesians regression model was fit adjusting for age, sex, season, neighborhood disadvantage, and the Elixhauser index of comorbidities.ResultsPostoperative complications increased in a dose-dependent manner with higher concentrations of PM2.5exposure, with a relative increase of 7% in the odds of complications for every 10ug/m3 increase in the highest single-day 24-hr PM2.5exposure during the 7 days prior to surgery. The association persisted after controlling for comorbidities and potential confounders; our inferences were robust to modeling choices and sensitivity analysis.Discussion & ConclusionIn this large Utah cohort, exposure to elevated PM2.5concentrations in the week before surgery was associated with increased postoperative complications in a dose-dependent manner, suggesting a potential impact of air pollution on surgical outcomes. These findings merit replication in larger datasets to identify populations at risk and to define the interaction and impact of different pollutants. PM2.5exposure is a potential perioperative risk factor and, given the unmitigated air pollution in urban areas, a global health concern.