SP59. Impact of High Food Swamp Scores and Insurance Coverage on Postoperative Complications in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quantitative Analysis

PURPOSE: “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. Additionally, the type of insurance coverage is increasingly recognized as a significant factor affecting postoperative outcomes. Quantitative data analyzing the combined effect of the interaction between food swamp environments and insurance type on surgical outcomes is limited. The present study aims to address this gap by assessing the combined impact on the rate of complications in patients who underwent Deep Inferior Epigastric Perforator (DIEP) flap-based breast reconstruction. METHODS: An institutional retrospective review of patients who underwent DIEP flap-based breast reconstruction between 2019 and 2022 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 food swamp score (FSS) for each county. The FSS were grouped into terciles and categorized as Low, Moderate, and High. Patient demographics, insurance types, comorbidities, and complication variables were collected. To assess the combined impact of food swamp environments and insurance type on postoperative outcomes, interaction variables between categorized FSS and insurance types were created. Regression analysis was utilized to analyze the interaction variables as a predictor of complications. RESULTS: A total of 482 patients were identified for inclusion. The distribution of patients in Low, Moderate, or High FSS counties was 30.5%, 16.2%, and 39.7%, respectively. Insurance coverage was predominantly private/commercial (59%), Medicaid (23.5%), and Medicare (10.6%). The overall complication rate among the cohort was 34.7%, with the majority occurring among privately insured patients (53%) and patients residing in high FSS counties (46.3%). Regression analyses utilizing an interaction variable for high FSS and Medicare insurance demonstrated higher odds of overall complications (OR, 2.3, p=0.031), seroma (OR, 5.3, P = 0.01), readmission (OR, 5.75, P < 0.001), and unexpected ER visit (OR, 3.87, P = 0.012). CONCLUSION: Patients who underwent DIEP flap-based breast reconstruction in counties with High FSS and covered by Medicare insurance had statistically significant higher odds of complications. These findings suggest environmental aspects of “food swamps” combined with Medicare insurance may increase the risk of complications among this target population. Further research is required on the interplay between food-environmental factors and insurance type in surgical outcomes.