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

BackgroundWhile 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 PM2.5 may induce inflammation that interacts insidiously with the surgical stress response, leading to higher postoperative complications. MethodsWe conducted a single center, retrospective cohort study using data from 49,615 surgical patients living along Utahs Wasatch Front and who underwent elective surgical procedures at a single academic medical center from 2016-2018. Patients addresses were geocoded and linked to daily Census-tract level PM2.5 estimates. We hypothesized that elevated PM2.5 concentrations in the week 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 PM2.5 exposure, with a relative increase of 8% in the odds of complications (OR=1.082) for every 10ug/m3 increase in the highest single-day 24-hr PM2.5 exposure during the 7 days prior to surgery. For a 30 fold increase in PM2.5 (1 ug/m3 to 30ug/m3) the odds of complication rose to over 27% (95%CI: 4%-55%). The association persisted after controlling for comorbidities and confounders; our inferences were robust to modeling choices and sensitivity analysis. ConclusionsIn this large Utah cohort, exposure to elevated PM2.5 concentrations in the week before surgery was associated with a dose-dependent increase in postoperative complications, suggesting a potential impact of air pollution on surgical outcomes. These findings merit replication in larger datasets to identify populations at risk and define the interaction and impact of different pollutants. PM2.5 exposure is a potential perioperative risk factor and, given the unmitigated air pollution in urban areas, a global health concern.