Objective: To compare the surgical outcomes for patients who live in neighborhoods of low and high air quality.

Background: Previous studies have established that patients in worse air quality environments experience unfavorable outcomes for many common medical conditions. Whether neighborhood air quality influences outcomes after surgery remains unclear.

Methods: We performed a retrospective cohort study between 2016-2020 of Medicare beneficiaries ages 65-99 years who underwent one of four common procedures (appendectomy, cholecystectomy, colectomy, and hernia repair). Home residential neighborhood air quality as measured by mean annual percent of days with daily 24-hour average PM2.5 concentrations over the National Ambient Air Quality Standard. We performed multivariable logistic regressions accounting for patient and hospital factors to calculate risk-adjusted rates of 30-day pulmonary complications, serious pulmonary complications, 30-day mortality, and readmissions between worst and best deciles of neighborhood air quality.

Results: We evaluated 1,262,012 beneficiaries. A larger proportion of black beneficiaries resided in the worst air quality decile (12.3%vs. 1.9%,P<0.001). Beneficiaries living in neighborhoods with poorer air quality had worse risk-adjusted outcomes than those residing in the neighborhoods with the best air quality. Specifically, those in the neighborhoods with the worst air quality had higher rates of serious pulmonary complications (8.5%vs. 7.3%,P<0.001), other serious complications (16.0%vs. 13.2%,P<0.001), and 30-day mortality (5.8%vs. 5.6%,P<0.001).

Conclusions: Medicare beneficiaries dwelling in neighborhoods with worse annual air quality undergoing common surgical procedures experienced higher rates of risk-adjusted adverse outcomes. These findings raise concerns about environmental exposures negatively impacting surgical outcomes.