Advisor(s)

Ruzmynn Vilcassim

Committee Member(s)

Daniel Chu
Jeffrey Wickliffe

Document Type

Thesis

Date of Award

6-4-2026

Degree Name

Master of Science in Public Health (MSPH)

School

School of Public Health

Department

Environmental Health Sciences

Abstract

Air pollution exposure has been linked to many surgically managed diseases and adverse health events that occur in the postoperative period. Despite this, the impact of air pollution on postoperative recovery is poorly understood. This knowledge gap may be one of the underlying mechanisms for persistent disparities in surgical outcomes. Previous studies have found racial and economic disparities in air pollution exposure. These same communities have been shown to experience worse surgical outcomes. The goal of this thesis is to explore if exposure to air pollution impacts surgical outcomes and determine if disparities in socioeconomic factors impact this relationship. The foundation of this thesis is robust institutional clinical data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Importantly, the institutional database specifically allows for geolinking to geographical estimates of environmental and economic factors. Four sources of air pollution data were linked to clinical data. Pollution data included (1) the Environmental Justice Index’s composite measure of environmental exposure and subdomains, (2) county level ground level monitor data from the Environmental Protection Agency’s (EPA) central monitors, and (3) land use regression data from the Center for Air, Climate and Energy Solutions (CACES). Finally, air pollution associated elemental concentrations in surgical tissue specimens were determined using X-Ray Fluorescence (XRF). Analysis of patient characteristics revealed multiple signs of disparities in terms of environmental exposures, with Black patients being more likely to live in areas high environmental burden and higher particulate matter. For postoperative outcomes, both gaseous and solid air pollutants were found to negatively impact surgical recovery. Patients were found to have longer lengths of stay based on PM2.5 the day of admission and for PM2.5, NO2 and SO2 the year of surgery. Patients were more likely to experience a complication if they lived in a census tract with higher air pollution exposure or increased proximity to transportation infrastructure as captured within the EJI. Infectious complications were found to be more common for patients residing in census tracts higher air pollution, high PM2.5, and increased proximity to transportation infrastructure. Further, risk for sepsis and pneumonia were associated with increased PM2.5.

Keywords

air pollution;environmental exposure;particulate matter;socioecological determinants of health;surgical disparities

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