(Re)Scheduling Pollution Exposure: The Case of Surgery Schedules and Patient Mortality

Abstract

Many human activities can be strategically timed around forecastable natural hazards to mute their impacts. We study air pollution shock mitigation in a high-stakes healthcare setting: hospital surgery scheduling. Using newly available inpatient surgery records from a major city in China, we track post-surgery survival for over 1 million patients, and document a significant increase of hospital mortality among those who underwent surgeries on days with high particulate matter pollution. This effect has two special features. First, pollution on the surgery day, rather than exposure prior to hospitalization, before or after the surgery, is primarily explanatory of the excess mortality. Second, a small but high-risk group – elderly patients undergoing respiratory or cancer operations – bears a majority of pollution’s damages. Based on these empirical findings, we build and analyze a model of hospital surgery scheduling. For over a third of the high-risk surgeries, there exists an alternative, lower-pollution day within three days such that moving the surgery may lead to a Pareto improvement in survival. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.