Surgery in the Pyrocene: Examining the Risk of Wildfire Smoke to Perioperative Patient Populations in the Mountain West

Across the Western U.S., the number of large wildfires has been steadily increasing since the early 1980s leading to degraded air quality. Wildfire smoke is known to worsen cardiopulmonary and neurovascular outcomes, however its impact on surgical patients is unstudied. Surgical populations are especially vulnerable to wildfire smoke due to the surgical inflammatory response which can synergize with pollution related inflammation. We hypothesize that patients presenting for surgery during wildfire smoke events will experience worsened perioperative outcomes (e.g. stroke, MI) compared to clean air days.

To characterize the health risk of wildfire smoke, linkages are needed that can attribute specific elevated smoke components (e.g PAHs, PM2.5) to specific source regions. We will leverage a smoke transport model (STILT), developed by Co-I Mallia and Wilmot, which can trace the origin of elevated PM2.5 levels to specific wildfires and use this funding to extend model timeframes. The smoke model will then be combined with perioperative outcomes, patient addresses, and traffic pollution, building on prior work from Co-I's Pearson and Wan from the Departments of Anesthesiology and Geography. Differentiating upstream smoke events from downstream pollution will enable better understanding of the pathophysiological mechanisms behind inflammatory responses to these varied sources. This non-traditional, cross-campus collaboration will enable us to characterize the risk to patients undergoing surgery and devise countermeasures, such as in-home filtration, PPE, and dynamic surgical scheduling, based on air quality.

This team will tackle a complex problem, the impact of wildfire smoke on perioperative health, and test the feasibility of this field of inquiry while supporting student researchers. If successful, we hope to build multi-institutional collaborations and obtain extramural funding from sources such as the NIH’s Climate Change and Health NOSI (NOT-ES-22-006).

Current Status

2024-03-19
This IU4U project aims to identify wildfire smoke's health risks to surgical patients by leveraging the STILT smoke transport model developed by Co-Investigator (Co-I) Mallia. Co-I Mallia has provided the team with updated STILT model results for the Wasatch Front, where UHealth's surgical patients reside. With the model's completion, the Anesthesiology team is analyzing the data to assess perioperative outcomes' risks. Simultaneously, we presented preliminary findings from a related air pollution study at the 18th Annual World Congress of Anesthesiologists, linking pre-operative PM2.5 exposure to a higher incidence of strokes, heart attacks, and other complications. This research earned 3rd place for best clinical abstract. Furthermore, we have initiated a collaboration with air quality epidemiology specialist Dr. Matt Strickland at the University of Nevada Reno. This partnership aims to enhance our exposure modeling and apply the STILT model more effectively by distinguishing smoke exposure sources, a factor identified in prior research as crucial for determining health impacts.