Air pollution, particularly fine particulate matter (PM₂.₅), is a recognized environmental risk factor that contributes to systemic inflammation, oxidative stress, and impaired cardiopulmonary function—factors associated with increased morbidity and premature mortality [1,2]. Notably, exposure to air pollution is not evenly distributed, and low-income populations more likely to reside in high-pollution neighborhoods, raising concerns about environmental contributors to the disease burden [2].
Emerging evidence suggests that exposure to air pollution may influence postoperative complications after major surgery, including cardiac and respiratory diseases, infections, and increased mortality, particularly among older adults [3]. While its role in chronic disease is well established, the impact of air pollution on surgical outcomes remains underexplored [4].
To address this gap, Dimick et al., evaluated over 1.2 million Medicare beneficiaries undergoing common surgical procedures and assessed whether residential exposure to poor air quality (defined by neighborhood-level exceedance of PM₂.₅ standards) was associated with worse postoperative outcomes, including pulmonary complications, serious complications, and 30-day mortality. It was noted that people who have undergone common surgical procedures and living in neighborhoods with worse annual air quality experienced higher rates of adverse outcomes (see Graphic) [4].
(Source: 1. Pope CA, Dockery DW. Health effects of fine particulate air pollution: Lines that connect. J Air Waste Manag Assoc. 2006;56(6):709–42. 2. Mikati I, Benson AF, Luben TJ, et al. Disparities in distribution of particulate matter emission sources by race and poverty status. Am J Public Health. 2018;108(4):480–85. 3. Chuang SH, Kuo YJ, Huang SW, et al. Association between long‑term exposure to air pollution and the rate of mortality after hip fracture surgery in patients older than 60 years: Nationwide cohort study in Taiwan. JMIR Public Health Surveill. 2024;10:e46591. Doi:10.2196/46591. 4. Dimick ME, Kunnath N, Ibrahim AM, Mullens CL. Association between neighborhood air pollution and outcomes after common surgical procedures. Ann Surg. 2025. DOI: 10.1097/SLA.0000000000006781)