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Background:
Wildfire smoke exposure is an increasingly important climate-related health concern, particularly in California. Fine particulate matter from wildfire smoke can contribute to cardiopulmonary stress, which may be especially relevant for patients undergoing thoracic surgery. Prior work has suggested that wildfire exposure during recovery from lung cancer surgery is associated with worse overall survival, highlighting surgical patients as a potentially vulnerable population. However, the relationship between wildfire smoke exposure and short-term perioperative outcomes remains less well characterized.

Objective:
This project aims to evaluate whether wildfire-attributable fine particulate matter exposure is associated with adverse perioperative outcomes among patients undergoing thoracic surgery at UCLA.

Methods:
This project is designed as a retrospective cohort study using thoracic surgery outcomes data from UCLA and wildfire-attributable particulate matter exposure estimates. The study team has identified the relevant clinical outcome dataset and exposure data sources, and institutional review board approval is currently pending before accessing patient-level outcome data. Once approved, patient-level surgical data will be linked to environmental exposure estimates using available geographic and temporal variables, including residential ZIP code and date of surgery. Planned exposure windows include short-term perioperative exposure and longer-term preoperative exposure. Outcomes of interest include postoperative complications and 30-day perioperative outcomes available in the thoracic surgery dataset. Planned analyses include descriptive characterization of wildfire smoke exposure among thoracic surgery patients and regression-based modeling to examine associations between exposure and postoperative outcomes, adjusting for available clinical and demographic factors.

Results:
This project is currently in the protocol development and regulatory approval phase. The study question, exposure framework, and planned outcome domains have been identified, and the next step will be to obtain institutional review board approval to access and analyze the thoracic surgery outcome data. After approval, the analysis will summarize wildfire-attributable particulate matter exposure across the study population and compare perioperative outcomes across exposure levels. Results will be presented using descriptive statistics, exposure summaries, and adjusted models when feasible.

Conclusions:
This ongoing project examines the intersection of climate-related environmental exposure and perioperative medicine. By focusing on thoracic surgery patients, this study will evaluate whether wildfire smoke exposure may represent a measurable risk factor for postoperative morbidity. Although patient-level outcome analysis has not yet begun, the project builds on emerging evidence that wildfire exposure may adversely affect surgical recovery and seeks to extend this work to short-term perioperative outcomes. Findings may inform future studies on environmental risk assessment, surgical preparedness, and climate-sensitive care for medically vulnerable patients.