Food Access as a Predictor of Readmission and Re-operation Following Long-segment Lumbar Fusion

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 long-segment lumbar fusion.

Methods: We retrospectively reviewed all adult patients at a single institution from 2011 to 2023 who underwent open and minimally invasive long-segment lumbar spine fusion, defined as > 4 levels. 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. Univariate comparison analysis as well as multivariate logistic regression was utilized to assess the association of food access with readmissions, re-operations, and complications.

Results: We identified 511 patients who met the inclusion criteria. The median age at time of operation was 65 (IQR 57-72) and 151 (30%) resided in a region of low food access. In multivariate regression analysis, patients in low food access regions had independently increased odds of readmission at 30 days (aOR 3.12, 95% CI 1.23–8.18, p=0.017), and reoperation at 90 days (aOR 2.07, 95%CI 1.04 – 4.11, p=0.038). In univariate comparison between the two groups, patients with low access to food were more likely to have wound-related complications after index surgery (6.9% vs 2.6%, p=0.02) and increased reoperation rates within 30 days (6.3% vs 1.7%, p =0.006), 90 days (11% vs 5.7%, p =0.027), and one year (22% vs 13%, p=0.027).

Conclusion : Low food access is a risk factor for unplanned readmissions and re-operations following lumbar spine surgery. Nutritional access may be an underlying driver of socioeconomic disparity impacting long-segment lumbar fusion.