Resident University of Alabama at Birmingham University of Alabama at Birmingham Birmingham, AL, US
Introduction: Recent studies have highlighted the importance of identifying socioeconomic risk factors for patients undergoing spine surgery. In the Deep South 15-20% of adults face food insecurity representing a significant portion of the population at risk of inadequate nutrition. Existing literature has linked nutritional status with adverse postoperative outcomes in lumbar spine surgery. The current study evaluates low food access as a risk factor for unplanned readmissions following lumbar deformity correction.
Methods: We retrospectively reviewed adult patients at a single institution 2011 to 2023 who underwent open and minimally invasive lumbar deformity correction using CPT/ICD9/10 codes. Addresses were geocoded and linked with nutrition access. Low food access was designated low food access census tracts where >100 households have no vehicle and >0.5 miles from a grocery store, in accordance with the HRSA. Propensity score matching and multivariate analyses were performed to assess the effect of low food access on readmission rates and complications.
Results: 544 patients met inclusion criteria. Twenty-seven percent of patients resided in low food access tracts. Upon multivariate regression analysis, patients in low food access regions had higher odds of reoperation within 30 days (OR 3.14, p =0.039) and readmission within 90 days (OR 2.8, p=0.006) after index operation. After propensity score matching patients in low food access regions were more likely to have wound disruption in the post-operative period (5.6% vs 1.5%, p=0.028) and higher rates of reoperation within 90-days of index surgery (9.2% vs 4.1%, p=0.037). There was no difference in one-year readmission or reoperation rates.
Conclusion : Low food access is a risk factor for unplanned readmissions and reoperations following lumbar spine surgery. Nutritional access may be an underlying driver of socioeconomic disparity impacting lumbar deformity outcomes.