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Impact of High Food Swamp Scores on Breast Reduction Outcomes
Keisha Montalmant
*, Olachi Oleru, Nargiz Seyidova, peter shamamian, Daniel Y. Kwon, Esther Kim, Carol Wang, Abena Gyasi, Peter W. Henderson
Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, Nesconset, NY
Background: "Food swamps" are defined as areas with a high density of fast-food restaurants (unhealthy foods) relative to grocery stores (healthy foods). Patients in these regions have an increased burden in accessing healthy foods and may have worse surgical outcomes due to suboptimal nutrition. Quantitative data related to its effect on surgical outcomes is limited. As such, the present study assesses the rate of complications in breast reduction (BR) patients residing in regions with high food swamp scores (FSS).
Methods: An institutional retrospective review of patients who underwent BR surgery between 2015 and 2023 was conducted. The USDA Food Environment Atlas was accessed to identify New York county-level data. The Retail Food Environment Index (the ratio of fast food restaurants to grocery stores) was used to calculate a FSS for each county. The FSS were grouped into terciles and categorized as Low, Moderate, and High. Demographics, comorbidities, and complication variables were collected. Regression analysis was utilized to analyze FSS as a predictor of complications.
Results: A total of 1,052 patients (1,965 breasts) were identified for inclusion. The distribution of patients in Low, Moderate, or High FSS counties was 40.6%, 24.9%, and 34.5%, respectively. A higher rate of non-White patients resided in a High FSS county (66.1% versus 33.8%, p <0.001). Higher body mass index (> 25 kg/m
2) was linked to High FSS (p=0.01). The overall complication rate was 11.9%. Reoperations occurred in 31 patients, of which 19.4% resided in a Low FSS county, 32.3% in a Moderate FSS county, and 48.4% in a High FSS county. Regression analyses demonstrated higher odds of reoperations in patients in High FSS counties (OR, 3.1, p=0.02).
Conclusions: Breast reduction patients in High FSS counties had statistically significantly higher odds of reoperation. These findings suggest environmental aspects of "food swamps" may lead to a greater risk of complications in BR patients. Further research on the interplay between food-environmental factors and surgical outcomes is required.
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