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Take A Deep Breath: Air Pollution Is Associated With Worse Outcomes After Congenital Heart Surgery
Sahithi Bhavana, MBBS1, Rachel Johnstone, MM2, Anya Schroeter, BA3, Kayley Ross, MPH1, Tara Karamlou, MD, MSc4, Anusha Jegatheeswaran, MD, PhD, FRCSC5, Meredith C. G. Broberg, MD1, Monir Hossain, PhD6, Karl F. Welke, MD, MS7.
1Akron Children's Heart Center, Akron, OH, USA, 2Northeast Ohio Medical University, School of Medicine, Rootstown, OH, USA, 3Case Western Reserve University School of Medicine, Cleveland, OH, USA, 4Akron Children's and Cincinnati Children's Hospital Medical Center, Akron, OH, USA, 5Great Ormond Street Hospital, London, United Kingdom, 6Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 7Atrium Health Levine Children's Hospital, Wake Forest University School of Medicine, Charlotte, NC, USA.
Objective(s): Air pollution has an outsized impact on children. Despite the risk, the association between air pollution and congenital heart surgery(CHS) outcomes is unclear. The purpose of this investigation is to determine the associations between air pollution, social vulnerability, and CHS outcomes.
Methods: Patients ≤18 years who underwent CHS were identified in the 2020 State Inpatient Databases(21 states) using RACHS-2 and were linked to the CDC Environmental Justice Index(EJI). Associations of EJI Social Vulnerability Module(SVM) and Air Pollution Domain(APD) with in-hospital mortality, length-of-stay(LOS), respiratory complications, and composite complications (stroke, renal failure, prolonged ventilation, deep sternal wound infection, sepsis) were tested using multivariable regression.
Results: Among 11,458 CHS patients across 21 states, neighborhood-level social vulnerability(SVM) and air pollution(APD) were independently associated with prolonged LOS. Each 10-percentile increase in SVM and APD ranking was associated with 1.55%(p<0.0001) and 0.56%(p=0.081) days increase in LOS, respectively. APD was independently associated with postoperative morbidity, including both respiratory complications(OR 1.04, p<0.0001) and composite complications(OR 1.08, p<0.0001). Neither SVM(p=0.99) nor APD(p=0.82) were associated with in-hospital mortality.
Conclusions: Environmental factors, such as air pollution, add additional layers of previously unappreciated risk modifiers for CHS patients. These findings advance our understanding of variability in clinical outcomes and suggest that air pollution and broader environmental justice factors may contribute to differences in outcomes that are not fully explained by traditional patient-level or in-hospital risk factors.
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