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Association of Shanghai air pollution with postoperative infection in adolescent orthopedic patients: a study using a
Yufeng Wang1, Yang Yuan1, Yang Liu1
1Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
Surgical site infections (SSI) represent severe complications in adolescent orthopedic surgery. Shanghai's complex air pollution profile creates a critical context to investigate multi-pollutant impacts on SSI risk in this vulnerable population.
Methods:
We analyzed 32,261 adolescent SSI cases from Shanghai (2019-2024) alongside high-resolution pollution/meteorological data. An evolutionary deep learning model (CNN-BiGRU-Attention optimized by Improved StarFish Algorithm) and generalized additive models (GAMs) assessed lagged effects, age/gender stratification, and concentration-response relationships.
Results:
NO2 and SO2 showed significantly positive associations with SSI risk at lag0 (concurrent day); O3 exhibited protective effects (strongest at lag05: -2.396% [95% CI: -3.349% to -1.443%] per 10 μg/m3 increase); Age stratification: 7-14 ages groups demonstrated heightened sensitivity to NO2/SO2. O3 effects varied across age groups; Gender differences: O3's negative association was stronger in males; Dose-response: NO2/SO2 showed monotonic increases with no safety thresholds; O3 displayed a straight line curve.
Conclusion:
Multi-pollutant exposure modulates SSI risk in adolescents, with NO2/SO2 as risk factors and O3 showing context-dependent protection. Deep learning identified SO2/NO2/O3 as dominant predictors, supporting perioperative air-quality interventions.