The association of food deserts with readmission and re-operation following long-segment lumbar fusion.

Abstract

Nutrition is increasingly recognized as a key determinant of postoperative recovery in spine surgery. An estimated 17% of U.S. adults reside in a food desert, reflecting a substantial population at risk for poor nutritional status. However, the role of residence in food deserts with spinal fusion outcomes remains unknown. We sought to investigate the association between living in a food desert and rates of reoperation and postoperative complications after long-segment lumbar fusion. We retrospectively reviewed all adult patients at a single institution from 2011 to 2023 who underwent open long-segment (≥ 4 levels) lumbar spine fusion. Patient addresses linked with residence in a food desert as defined by the Economic Research Service. Multivariate logistic regressions were utilized to assess the association of food deserts with readmissions and reoperations. We identified 354 patients [median age at time of operation was 66 (IQR 59-72)] who met the inclusion criterion, of which 123 (35%) resided in a food desert. Patients in a food desert had higher neighborhood deprivation (80 vs 59, p < .001) and did not have differences in BMI (29.8 vs 29.9 p = .4). In multivariate regression analysis adjusting for frailty, clinical, socioeconomic, and operative characteristics, patients residing in a food desert had independently increased odds of re-operation within one year (OR 1.84, 95%CI 1.03-3.30) and readmission due to infection or wound breakdown (OR 3.09, 95%CI 1.03-10.1). Patients residing in a food desert were more likely to require reoperation for wound revision (8.9% vs 3.0%, p = .016) within one year. Using weighted survival analysis, patients who lived in a food desert had sooner times to reoperation (p = .045). Residence in a food desert may be a risk factor for reoperations following long segment lumbar spine surgery. Nutritional access may be an underlying driver of socioeconomic disparity impacting long-segment lumbar fusion.