Ambient Air Pollution and Thoracic Surgery Outcomes: Assessing the Impact of Particulate Matter

Air pollution has been linked to poor outcomes after heart and lung transplants, but it is unclear if this environmental exposure impacts outcomes after other thoracic procedures. We hypothesized that patients from areas with higher air pollution would experience worse postoperative outcomes.

In this retrospective cohort study, institutional American College of Surgeons National Surgical Quality Improvement Program data from 2009-2022 were linked to the Environmental Justice Index (EJI). Adult patients who underwent an esophagectomy, lobectomy, sublobar resection, or paraesophageal hernia repair were included. Patient home census tract was linked to national percentile social vulnerability and particulate matter less than 2.5 microns in diameter (PM_2.5) from the Environmental Justice Index. Outcomes included complications and readmission.

Patients from areas with high PM_2.5 were more likely to be Black (21.0% vs 12.1%, P < .001) and have high environmental burden (67.0% vs 32.9%, P < .001), but less likely to live in area with high social vulnerability (52.6% vs 77.6%, P < .001). On multivariable logistical regression, patients living in a census tract with high PM_2.5 had increased odds of experiencing an infectious postoperative complication (adjusted odds ratio, 2.53; 95% CI, 1.05-6.08).

In this study of air pollution and surgical outcomes, we found that Black patients were more likely to experience high ambient PM_2.5 exposures and that thoracic patients with high ambient PM_2.5 exposures were more likely to experience an infectious complication. This highlights a possible mechanism for persistent disparities.