Association of Shanghai air pollution with postoperative infection in adolescent orthopedic patients: a study using a...

Area of Science:

• Environmental Health
• Pediatric Surgery
• Data Science

Background:

• Surgical site infections (SSI) are serious complications in adolescent orthopedic surgery.
• Shanghai's air pollution presents a unique challenge for studying multi-pollutant effects on SSI risk in adolescents.

Purpose of the Study:

• To investigate the association between air pollution and SSI risk in adolescents undergoing orthopedic surgery in Shanghai.
• To explore the differential impacts of various pollutants (NO2, SO2, O3) and their lagged effects on SSI risk, considering age and gender.

Main Methods:

• Analysis of 32,261 adolescent SSI cases (2019-2024) in Shanghai.
• Utilized a deep learning model (CNN-BiGRU-Attention with Improved StarFish Algorithm) and generalized additive models (GAMs).
• Assessed lagged effects, age/gender stratification, and concentration-response relationships for air pollutants.

Main Results:

• Nitrogen dioxide (NO2) and sulfur dioxide (SO2) showed significant positive associations with SSI risk.
• Ozone (O3) exhibited protective effects, particularly at lag05 (-2.396% per 10 μg/m³ increase).
• Adolescents aged 7-14 were more sensitive to NO2/SO2; O3 effects varied by age and were more protective in males.

Conclusions:

• Multi-pollutant exposure significantly influences adolescent SSI risk.
• NO2 and SO2 act as risk factors, whereas O3 demonstrates context-dependent protective effects.
• Deep learning identified SO2, NO2, and O3 as key predictors, supporting the need for perioperative air quality interventions.