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Residing in a Food Desert is Associated with an Increased Risk of Complications Following Breast Reconstruction
Christian X. Lava, MS1,2, Varsha Harish, BS1, Karen R. Li, BA1,2, Alexandra Junn, MD2, Nicolas Greige, MD2, Ilana G. Margulies, MD2, Rajiv P. Parikh, MD2,4, Kenneth L. Fan, MD2
1Georgetown University School of Medicine; Washington, DC, USA; 2Department of Plastic and Reconstructive Surgery, MedStar Georgetown University, Hospital; Washington, DC, USA; 3Department of Breast Surgery, Medstar Georgetown University Hospital; Washington, DC, USA; 4Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center, Washington, DC, USA.

Background

FDs are areas with high food insecurity due to low access to healthy food and a concentration of non-healthy food venues.1 Food insecurity leads to about a 10% increase in body mass index (BMI), which correlates with increased complications following autologous breast reconstruction (ABR).1-8 Few studies explore FDs' effects on postoperative outcomes after ABR. This study aims to 1) describe comorbidity burden in patients residing in FDs and 2) assess FD residence's effects on postoperative outcomes following DIEP breast reconstruction.

Methods

A multicenter retrospective review of patients undergoing DIEP reconstruction from 2014 to 2018 was conducted. Patient characteristics and postoperative outcomes were collected. Addresses were classified as low food access (LFA) if residents lived more than 0.5 miles (urban) or 10 miles (rural) from the nearest supermarket.9 Primary outcomes included minor (e.g., seroma, hematoma, dehiscence) and major (i.e., return to the operating room) complications. Subanalysis of the LFA group was performed by income, where low income (LI) was defined as ≤80% of the state-wide median family income.

Results

Out of 1553 patients, 675 (43.5%) resided in LFA areas and 878 (56.5%) in non-low food access (NLFA) areas. Mean BMI was 28.4±8.0 and 28.6±7.3 kg/m2, respectively (p=0.897). LFA patients had a mean Charlson Comorbidity Index of 2.6±1.3 compared to 2.3±1.2 for NLFA (p<0.001). The LFA group experienced more minor complications than the NLFA group (n=190, 28.1% vs. n=187, 21.3%, respectively p=0.002). LFA sub-analysis revealed LI patients had a higher incidence of reoperation (n=28/158, 17.7% vs. n=55/517, 10.6%; p=0.018). Multivariate analysis revealed significant associations between food access and major complications (OR=1.80, 95% CI:1.21-2.67, p=0.004).


Conclusion

The findings suggest a relationship between food access, comorbidity burden, and post-operative complications, underscoring the need for pre-operative food insecurity screening. Further studies are warranted to better assess the FDs' impact on post-operative outcomes.

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