The impact of environmental burden on surgical outcomes

Socioecological determinants of health are known to impact surgical outcomes, but the role of environmental stressors is unclear. We sought to use the novel Environmental Justice Index to assess if surgical outcomes were impacted by environmental burden.

In this regional cross-sectional study, institutional National Surgical Quality Improvement Program data were linked to environmental burden data from the Centers for Disease Control and Prevention's Environmental Justice Index. Patients who underwent surgery across 8 specialties from 2006 to 2022 were included. Outcomes of interest included morbidity, mortality, and readmission. Analysis included χ² test, analysis of variance, and multivariable logistic regression.

Among 12,378 surgical patients, the median age was 60.6 years, 57.5% were female, 31.7% were Black, and the majority came from census tracts in the top 2 environmental burden quartiles (61.2% combined). On multivariable logistic regression, increased environmental burden was associated with increased odds of experiencing a complication (adjusted odds ratio, 1.34; 95% confidence interval, 1.09-1.67). In subset analyses of subdomains, air pollution and proximity to transportation infrastructure were associated with increased adjusted odds of experiencing a complication: 1.38 (1.02-1.87) and 1.36 (1.08-1.70), respectively. Infectious complications were associated with increased air pollution, proximity to transportation infrastructure, and proximity to hazardous sites.

In this novel use of the Environmental Justice Index, we found that environmental burden is associated with worse surgical outcomes, including complications, with air pollution and proximity to transportation subdomains most strongly associated. This highlights a possible mechanism for persistent disparities that can be targeted with policy.