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Effects of Air Quality on Peri-Operative Outcomes after Robotic-Assisted Lobectomy
Maykel Dolorit1, Ajay Varadhan1, Diep Nguyen1, Gregory Fishberger1, Collin Chase1, Sarah Cool1, Jessica Cobb1, Harrison Strang1, Emily Weeden1, Rahul Mhaskar1, Joseph R. Garrett1, Carla C. Moodie1, Jacques P. Fontaine2, Jenna Tew2, Jobelle J.A.R. Baldonado2, Eric M. Toloza2.
1USF Morsani Colloge of Medicine, TAMPA, FL, USA, 2Moffitt, TAMPA, FL, USA.

OBJECTIVE: : Air Quality Index (AQI) measures five major air pollutants regulated by the Clean Air Act, namely ground-level ozone, particle pollution (PM2.5/PM10), carbon monoxide, sulfur dioxide, and nitrogen dioxide. In 2013, the International Agency for Research on Cancer (IARC) classified air pollution as a major carcinogen. Lung cancer prevalence has been reported to be higher in cities with poor air quality. We studied whether patientsí residential AQI affected perioperative outcomes after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy
METHODS: We retrospectively analyzed 710 consecutive patients who underwent RAVT pulmonary lobectomy by one surgeon over 10.8 years. Using the patientsí residential ZIP code and date of surgery, mean AQI for the counties corresponding to those ZIP codes during the surgery year was extracted from the United States Environmental Protection Agency (EPA). Perioperative outcomes were compared using Chi-Square (χ2), Studentís t-test, and Kruskal-Wallis tests, with p≤0.05 as significant.
RESULTS: No significant differences were found among perioperative outcomes between patient groups based on patientsí county mean AQI (Table 1). However, patients who had intraoperative pulmonary artery (PA) bleeding experienced better mean AQI (p=0.03), while most patients who had previous cancer experienced worse mean AQI (p=0.005).
CONCLUSIONS: Although worse AQI is associated with increased lung cancer prevalence, this study could not demonstrate a link between patientsí residential AQI with most perioperative outcomes after RAVT pulmonary lobectomy, except for intraoperative PA bleeding and previous cancer. Further investigation of patientsí demographics, smoking histories, and preoperative comorbidities may yield intermediary variables linking AQI and intraoperative PA bleeding.


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