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<!DOCTYPE html> <html lang="en" dir="ltr" xmlns="http://www.w3.org/1999/xhtml" xmlns:mml="http://www.w3.org/1998/Math/MathML"> <head prefix="og: http://ogp.me/ns# article: http://ogp.me/ns/article# book: http://ogp.me/ns/book#" >  <link rel="dns-prefetch" href="//d33xdlntwy0kbs.cloudfront.net" /> <link rel="dns-prefetch" href="//cdn.jsdelivr.net" /> <link rel="dns-prefetch" href="//www.google.com" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <link rel="dns-prefetch" href="//www.googletagmanager.com" /> <link rel="dns-prefetch" href="//rum-static.pingdom.net" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://www.medrxiv.org/sites/default/files/images/favicon.ico" type="image/vnd.microsoft.icon" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <meta name="type" content="article" /> <meta name="category" content="article" /> <meta name="HW.identifier" content="/medrxiv/early/2024/11/14/2024.08.13.24311943.atom" /> <meta name="HW.pisa" content="medrxiv;2024.08.13.24311943v2" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="Preoperative Exposure to Fine Particulate Matter and Risk of Postoperative Complications: A Single Center Observational Cohort Bayesian Analysis" /> <meta name="DC.Identifier" content="10.1101/2024.08.13.24311943" /> <meta name="DC.Date" content="2024-11-14" /> <meta name="DC.Publisher" content="Cold Spring Harbor Laboratory Press" /> <meta name="DC.Rights" content="© 2024, Posted by Cold Spring Harbor Laboratory. The copyright holder for this pre-print is the author. All rights reserved. The material may not be redistributed, re-used or adapted without the author's permission." /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Description" content="Background While 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. Methods We conducted a single center, retrospective cohort study using data from 49,615 surgical patients living along Utah’s 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. Results Postoperative 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. Conclusions In 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. ### Competing Interest Statement Ben Goodrich and Jonah Gabry are both member-managers of GG Statistics, LLC. ### Funding Statement This study was funded from an intramural University of Utah Wilkes Center for Climate Science and Policy seed grant [to JFP and NW] as well as partially supported by the National Institute of Health National Institute of Environmental Health Sciences and National Cancer Institute (NIH grant 5R01ES029528-05 [to MS], 5R37CA276365-02 [to NW]). Further funding was from the National Science Foundation (NSF grant 2051246 [BG] and 2153019[BG]). The funding sources were not involved in the study design, collection, analysis and interpretation of the data, in writing the report, or in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the National Science Foundation, or the University of Utah Wilkes Center for Climate Science and Policy. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of the University of Utah gave ethical approval of this work as Category 4, Exempt with IRB approval number 00142167. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors." /> <meta name="DC.Contributor" content="John F. Pearson" /> <meta name="DC.Contributor" content="Cameron K. Jacobson" /> <meta name="DC.Contributor" content="Calvin S. Riss" /> <meta name="DC.Contributor" content="Matthew J. Strickland" /> <meta name="DC.Contributor" content="Longyin Lee" /> <meta name="DC.Contributor" content="Neng Wan" /> <meta name="DC.Contributor" content="Tabitha M. Benney" /> <meta name="DC.Contributor" content="Nathan L. Pace" /> <meta name="DC.Contributor" content="Ben K. Goodrich" /> <meta name="DC.Contributor" content="Jonah S. Gabry" /> <meta name="DC.Contributor" content="John V. Pham" /> <meta name="DC.Contributor" content="Cade K. Kartchner" /> <meta name="DC.Contributor" content="Jake S. Wood" /> <meta name="DC.Contributor" content="Michael H. Andreae" /> <meta name="article:published_time" content="2024-11-14" /> <meta name="citation_title" content="Preoperative Exposure to Fine Particulate Matter and Risk of Postoperative Complications: A Single Center Observational Cohort Bayesian Analysis" /> <meta name="citation_abstract" lang="en" content="<p>Background: While 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. Methods: We conducted a single center, retrospective cohort study using data from 49,615 surgical patients living along Utah9s Wasatch Front and who underwent elective surgical procedures at a single academic medical center from 2016-2018. Patients9 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. Results: Postoperative 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. Conclusions: In 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.</p>" /> <meta name="citation_journal_title" content="medRxiv" /> <meta name="citation_publisher" content="Cold Spring Harbor Laboratory Press" /> <meta name="citation_publication_date" content="2024/01/01" /> <meta name="citation_mjid" content="medrxiv;2024.08.13.24311943v2" /> <meta name="citation_id" content="2024.08.13.24311943v2" /> <meta name="citation_public_url" content="https://www.medrxiv.org/content/10.1101/2024.08.13.24311943v2" /> <meta name="citation_abstract_html_url" content="https://www.medrxiv.org/content/10.1101/2024.08.13.24311943v2.abstract" /> <meta name="citation_full_html_url" content="https://www.medrxiv.org/content/10.1101/2024.08.13.24311943v2.full" /> <meta name="citation_pdf_url" content="https://www.medrxiv.org/content/medrxiv/early/2024/11/14/2024.08.13.24311943.full.pdf" /> <meta name="citation_doi" content="10.1101/2024.08.13.24311943" /> <meta name="citation_num_pages" content="40" /> <meta name="citation_article_type" content="Article" /> <meta name="citation_firstpage" content="2024.08.13.24311943" /> <meta name="citation_author" content="John F. Pearson" /> <meta name="citation_author_institution" content="Department of Anesthesiology, University of Utah School of Medicine" /> <meta name="citation_author_institution" content="Global Change and Sustainability Center, University of Utah" /> <meta name="citation_author_email" content="johnf.pearson@utah.edu" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0003-1759-9518" /> <meta name="citation_author" content="Cameron K. Jacobson" /> <meta name="citation_author_institution" content="Department of Anesthesiology, University of Utah School of Medicine" /> <meta name="citation_author" content="Calvin S. Riss" /> <meta name="citation_author_institution" content="Department of Biostatistics, Epidemiology and Environmental Health, University of Nevada Reno School of Public Health" /> <meta name="citation_author" content="Matthew J. Strickland" /> <meta name="citation_author_institution" content="Department of Biostatistics, Epidemiology and Environmental Health, University of Nevada Reno School of Public Health" /> <meta name="citation_author" content="Longyin Lee" /> <meta name="citation_author_institution" content="School of Environment, Society and Sustainability, University of Utah" /> <meta name="citation_author" content="Neng Wan" /> <meta name="citation_author_institution" content="School of Environment, Society and Sustainability, University of Utah" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0001-8214-9164" /> <meta name="citation_author" content="Tabitha M. Benney" /> <meta name="citation_author_institution" content="Department of Political Science, University of Utah" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0001-5800-8919" /> <meta name="citation_author" content="Nathan L. Pace" /> <meta name="citation_author_institution" content="Department of Anesthesiology, University of Utah School of Medicine" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-8646-5276" /> <meta name="citation_author" content="Ben K. Goodrich" /> <meta name="citation_author_institution" content="Applied Statistics Center, Columbia University" /> <meta name="citation_author" content="Jonah S. Gabry" /> <meta name="citation_author_institution" content="Applied Statistics Center, Columbia University" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0001-6437-6144" /> <meta name="citation_author" content="John V. Pham" /> <meta name="citation_author_institution" content="Department of Anesthesiology, University of Utah School of Medicine" /> <meta name="citation_author" content="Cade K. 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Atmosphere 2020; 11" /> <meta name="citation_reference" content="Errigo IM, Abbott BW, Mendoza DL, Mitchell L, Sayedi SS, Glenn J, Kelly KE, Beard JD, Bratsman S, Carter T, Chaney RA, Follett A, Freeman A, Frei RJ, Greenhalgh M, Holmes HA, Howe PD, Johnston JD, Lange L, Martin R, Stacey A, Tran T, Wilson D: Human Health and Economic Costs of Air Pollution in Utah: An Expert Assessment. Atmosphere 2020; 11" /> <meta name="twitter:title" content="Preoperative Exposure to Fine Particulate Matter and Risk of Postoperative Complications: A Single Center Observational Cohort Bayesian Analysis" /> <meta name="twitter:site" content="@medrxivpreprint" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:image" content="https://www.medrxiv.org/sites/default/files/images/medrxiv_logo_homepage7-5-small-test-up.png" /> <meta name="twitter:description" content="Background While 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. Methods We conducted a single center, retrospective cohort study using data from 49,615 surgical patients living along Utah’s 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. Results Postoperative 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. Conclusions In 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. ### Competing Interest Statement Ben Goodrich and Jonah Gabry are both member-managers of GG Statistics, LLC. ### Funding Statement This study was funded from an intramural University of Utah Wilkes Center for Climate Science and Policy seed grant [to JFP and NW] as well as partially supported by the National Institute of Health National Institute of Environmental Health Sciences and National Cancer Institute (NIH grant 5R01ES029528-05 [to MS], 5R37CA276365-02 [to NW]). Further funding was from the National Science Foundation (NSF grant 2051246 [BG] and 2153019[BG]). The funding sources were not involved in the study design, collection, analysis and interpretation of the data, in writing the report, or in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the National Science Foundation, or the University of Utah Wilkes Center for Climate Science and Policy. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of the University of Utah gave ethical approval of this work as Category 4, Exempt with IRB approval number 00142167. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors." /> <meta name="og-title" property="og:title" content="Preoperative Exposure to Fine Particulate Matter and Risk of Postoperative Complications: A Single Center Observational Cohort Bayesian Analysis" /> <meta name="og-url" property="og:url" content="https://www.medrxiv.org/content/10.1101/2024.08.13.24311943v2" /> <meta name="og-site-name" property="og:site_name" content="medRxiv" /> <meta name="og-description" property="og:description" content="Background While 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. Methods We conducted a single center, retrospective cohort study using data from 49,615 surgical patients living along Utah’s 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. Results Postoperative 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. Conclusions In 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. ### Competing Interest Statement Ben Goodrich and Jonah Gabry are both member-managers of GG Statistics, LLC. ### Funding Statement This study was funded from an intramural University of Utah Wilkes Center for Climate Science and Policy seed grant [to JFP and NW] as well as partially supported by the National Institute of Health National Institute of Environmental Health Sciences and National Cancer Institute (NIH grant 5R01ES029528-05 [to MS], 5R37CA276365-02 [to NW]). Further funding was from the National Science Foundation (NSF grant 2051246 [BG] and 2153019[BG]). The funding sources were not involved in the study design, collection, analysis and interpretation of the data, in writing the report, or in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the National Science Foundation, or the University of Utah Wilkes Center for Climate Science and Policy. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of the University of Utah gave ethical approval of this work as Category 4, Exempt with IRB approval number 00142167. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors." /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://www.medrxiv.org/sites/default/files/images/medrxiv_logo_homepage7-5-small-test-up.png" /> <meta name="citation_date" content="2024-11-14" /> <link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/10.1101/2024.08.13.24311943v2.full.txt" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/10.1101/2024.08.13.24311943v2.ppt" /> <link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/10.1101/2024.08.13.24311943v2.full.pdf" /> <meta name="description" content="medRxiv - The Preprint Server for Health Sciences" /> <meta name="generator" content="Drupal 7 (http://drupal.org)" /> <link rel="canonical" href="https://www.medrxiv.org/content/10.1101/2024.08.13.24311943v2" /> <link 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class="highwire-article-citation highwire-citation-type-highwire-article node900735" data-node-nid="900735" id="node-900735--2352429939" data-pisa="medrxiv;2024.08.13.24311943v2" data-pisa-master="medrxiv;2024.08.13.24311943" data-apath="/medrxiv/early/2024/11/14/2024.08.13.24311943.atom" data-hw-author-tooltip-instance=""><div class="highwire-cite highwire-cite-highwire-article highwire-citation-medrxiv-article-top clearfix has-author-tooltip" > <h1 class="highwire-cite-title" id="page-title">Preoperative Exposure to Fine Particulate Matter and Risk of Postoperative Complications: A Single Center Observational Cohort Bayesian Analysis</h1> <div class="highwire-cite-authors" ><span class="highwire-citation-authors"><span class="highwire-citation-author first hw-author-orcid-logo-wrapper" data-delta="0"><a href="http://orcid.org/0000-0003-1759-9518" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">John F.</span> <span class="nlm-surname">Pearson</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Cameron K.</span> <span class="nlm-surname">Jacobson</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Calvin S.</span> <span class="nlm-surname">Riss</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Matthew J.</span> <span class="nlm-surname">Strickland</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Longyin</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="5"><a href="http://orcid.org/0000-0001-8214-9164" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Neng</span> <span class="nlm-surname">Wan</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="6"><a href="http://orcid.org/0000-0001-5800-8919" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Tabitha M.</span> <span class="nlm-surname">Benney</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="7"><a href="http://orcid.org/0000-0002-8646-5276" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Nathan L.</span> <span class="nlm-surname">Pace</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Ben K.</span> <span class="nlm-surname">Goodrich</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="9"><a href="http://orcid.org/0000-0001-6437-6144" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Jonah S.</span> <span class="nlm-surname">Gabry</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">John V.</span> <span class="nlm-surname">Pham</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">Cade K.</span> <span class="nlm-surname">Kartchner</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">Jake S.</span> <span class="nlm-surname">Wood</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="13"><a href="http://orcid.org/0000-0002-9052-0936" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Michael H.</span> <span class="nlm-surname">Andreae</span></span></span></div> <div class="highwire-cite-metadata" ><span class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">doi:</span> https://doi.org/10.1101/2024.08.13.24311943 </span></div> </div> <div id="hw-article-author-popups-node-900735--2352429939" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">John F. Pearson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Department of Anesthesiology, University of Utah School of Medicine</span></div><div class='author-affiliation'><span class='nlm-sup'>2</span><span class='nlm-institution'>Global Change and Sustainability Center, University of Utah</span></div>MD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=John%2BF.%2BPearson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pearson%20JF&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJohn%2BF.%2BPearson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link"><a href="http://orcid.org/0000-0003-1759-9518" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for John F. Pearson</a></li><li class="author-corresp-email-link last"><span>For correspondence: <a href="mailto:johnf.pearson@utah.edu" class="" data-icon-position="" data-hide-link-title="0">johnf.pearson@utah.edu</a></span></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Cameron K. Jacobson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Department of Anesthesiology, University of Utah School of Medicine</span></div>MS</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Cameron%2BK.%2BJacobson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jacobson%20CK&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ACameron%2BK.%2BJacobson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Calvin S. Riss </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>3</span><span class='nlm-institution'>Department of Biostatistics, Epidemiology and Environmental Health, University of Nevada Reno School of Public Health</span></div>BS</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Calvin%2BS.%2BRiss%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Riss%20CS&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ACalvin%2BS.%2BRiss%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Matthew J. Strickland </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>3</span><span class='nlm-institution'>Department of Biostatistics, Epidemiology and Environmental Health, University of Nevada Reno School of Public Health</span></div>PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Matthew%2BJ.%2BStrickland%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Strickland%20MJ&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMatthew%2BJ.%2BStrickland%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Longyin Lee </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>4</span><span class='nlm-institution'>School of Environment, Society and Sustainability, University of Utah</span></div>BS</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Longyin%2BLee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lee%20L&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ALongyin%2BLee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Neng Wan </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>4</span><span class='nlm-institution'>School of Environment, Society and Sustainability, University of Utah</span></div>PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Neng%2BWan%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wan%20N&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ANeng%2BWan%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-8214-9164" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Neng Wan</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Tabitha M. Benney </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>5</span><span class='nlm-institution'>Department of Political Science, University of Utah</span></div>PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Tabitha%2BM.%2BBenney%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Benney%20TM&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ATabitha%2BM.%2BBenney%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5800-8919" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Tabitha M. Benney</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Nathan L. Pace </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Department of Anesthesiology, University of Utah School of Medicine</span></div>MD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Nathan%2BL.%2BPace%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pace%20NL&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ANathan%2BL.%2BPace%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8646-5276" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Nathan L. Pace</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Ben K. Goodrich </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>6</span><span class='nlm-institution'>Applied Statistics Center, Columbia University</span></div>PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Ben%2BK.%2BGoodrich%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Goodrich%20BK&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ABen%2BK.%2BGoodrich%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">Jonah S. Gabry </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>6</span><span class='nlm-institution'>Applied Statistics Center, Columbia University</span></div>MS</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Jonah%2BS.%2BGabry%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gabry%20JS&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJonah%2BS.%2BGabry%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-6437-6144" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Jonah S. Gabry</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">John V. Pham </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Department of Anesthesiology, University of Utah School of Medicine</span></div>MD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=John%2BV.%2BPham%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pham%20JV&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJohn%2BV.%2BPham%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">Cade K. Kartchner </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Department of Anesthesiology, University of Utah School of Medicine</span></div>BS</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Cade%2BK.%2BKartchner%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kartchner%20CK&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ACade%2BK.%2BKartchner%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">Jake S. Wood </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>7</span><span class='nlm-institution'>Indiana University School of Medicine</span></div>BS</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Jake%2BS.%2BWood%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wood%20JS&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJake%2BS.%2BWood%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">Michael H. Andreae </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Department of Anesthesiology, University of Utah School of Medicine</span></div>MD-PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Michael%2BH.%2BAndreae%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Andreae%20MH&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AMichael%2BH.%2BAndreae%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9052-0936" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Michael H. Andreae</a></li></ul></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" > <div class="pane-content"> <div class="item-list"><ul class="tabs inline panels-ajax-tab"><li class="first"><a href="/content/10.1101/2024.08.13.24311943v2" class="panels-ajax-tab-tab" data-panel-name="biorxiv_tab_art" data-target-id="highwire_article_tabs" data-entity-context="node:900735" data-trigger="" data-url-enabled="1">Abstract</a><a href="/panels_ajax_tab/biorxiv_tab_art/node:900735/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/10.1101/2024.08.13.24311943v2.full-text" class="panels-ajax-tab-tab" data-panel-name="article_tab_full_text" data-target-id="highwire_article_tabs" data-entity-context="node:900735" data-trigger="full-text" data-url-enabled="1">Full Text</a><a href="/panels_ajax_tab/article_tab_full_text/node:900735/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/10.1101/2024.08.13.24311943v2.article-info" class="panels-ajax-tab-tab" data-panel-name="biorxiv_tab_info" data-target-id="highwire_article_tabs" data-entity-context="node:900735" data-trigger="article-info" data-url-enabled="1">Info/History</a><a href="/panels_ajax_tab/biorxiv_tab_info/node:900735/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/10.1101/2024.08.13.24311943v2.article-metrics" class="panels-ajax-tab-tab" data-panel-name="article_tab_metrics" data-target-id="highwire_article_tabs" data-entity-context="node:900735" data-trigger="article-metrics" data-url-enabled="1">Metrics</a><a href="/panels_ajax_tab/article_tab_metrics/node:900735/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/10.1101/2024.08.13.24311943v2.supplementary-material" class="panels-ajax-tab-tab" data-panel-name="biorxiv_tab_data" data-target-id="highwire_article_tabs" data-entity-context="node:900735" data-trigger="supplementary-material" data-url-enabled="1">Supplementary material</a><a href="/panels_ajax_tab/biorxiv_tab_data/node:900735/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/10.1101/2024.08.13.24311943v2.external-links" class="panels-ajax-tab-tab" data-panel-name="article_tab_data_code" data-target-id="highwire_article_tabs" data-entity-context="node:900735" data-trigger="external-links" data-url-enabled="1">Data/Code</a><a href="/panels_ajax_tab/article_tab_data_code/node:900735/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li class="last"><a href="/content/10.1101/2024.08.13.24311943v2.full.pdf+html" class="panels-ajax-tab-tab" data-panel-name="biorxiv_tab_pdf" data-target-id="highwire_article_tabs" data-entity-context="node:900735" data-trigger="full.pdf+html" data-url-enabled="1"><i class="icon-file-alt"></i> Preview PDF</a><a href="/panels_ajax_tab/biorxiv_tab_pdf/node:900735/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li></ul></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="biorxiv_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://www.medrxiv.org/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-biorxiv_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2 class="">Abstract</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>Background</strong> While exposure to fine particulate matter air pollution (PM<sub>2.5</sub>) is known to cause adverse health effects, its impact on postoperative outcomes in US adults remains understudied. Perioperative exposure to PM<sub>2.5</sub> may induce inflammation that interacts insidiously with the surgical stress response, leading to higher postoperative complications.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>Methods</strong> We conducted a single center, retrospective cohort study using data from 49,615 surgical patients living along Utah’s 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 PM<sub>2.5</sub> estimates. We hypothesized that elevated PM<sub>2.5</sub> 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.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>Results</strong> Postoperative complications increased in a dose-dependent manner with higher concentrations of PM<sub>2.5</sub> exposure, with a relative increase of 8% in the odds of complications (OR=1.082) for every 10ug/m<sup>3</sup> increase in the highest single-day 24-hr PM<sub>2.5</sub> exposure during the 7 days prior to surgery. For a 30 fold increase in PM<sub>2.5</sub> (1 ug/m<sup>3</sup> to 30ug/m<sup>3</sup>) 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.</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>Conclusions</strong> In this large Utah cohort, exposure to elevated PM<sub>2.5</sub> 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. PM<sub>2.5</sub> exposure is a potential perioperative risk factor and, given the unmitigated air pollution in urban areas, a global health concern.</p></div></div><h3>Competing Interest Statement</h3><p id="p-6">Ben Goodrich and Jonah Gabry are both member-managers of GG Statistics, LLC.</p><h3>Funding Statement</h3><p id="p-7">This study was funded from an intramural University of Utah Wilkes Center for Climate Science and Policy seed grant [to JFP and NW] as well as partially supported by the National Institute of Health National Institute of Environmental Health Sciences and National Cancer Institute (NIH grant 5R01ES029528-05 [to MS], 5R37CA276365-02 [to NW]). Further funding was from the National Science Foundation (NSF grant 2051246 [BG] and 2153019[BG]). The funding sources were not involved in the study design, collection, analysis and interpretation of the data, in writing the report, or in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the National Science Foundation, or the University of Utah Wilkes Center for Climate Science and Policy.</p><h3>Author Declarations</h3><p id="p-8">I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.</p><p id="p-9">Yes</p><p id="p-10">The details of the IRB/oversight body that provided approval or exemption for the research described are given below:</p><p id="p-11">The Institutional Review Board of the University of Utah gave ethical approval of this work as Category 4, Exempt with IRB approval number 00142167.</p><p id="p-12">I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.</p><p id="p-13">Yes</p><p id="p-14">I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).</p><p id="p-15">Yes</p><p id="p-16">I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.</p><p id="p-17">Yes</p><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-update fn-group-summary-of-updates" id="fn-1"><p id="p-18">Revision for submission to new journal, and update to the cohort size after discovery of data wrangling issues. 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