The association of food deserts with readmission and re-operation following long-segment lumbar fusion

BACKGROUND: Nutrition is increasingly recognized as a key determinant of postoperative recovery in spine surgery. An estimated 17% of U.S. adults reside in a food desert, reflecting a substantial population at risk for poor nutritional status. However, the role of residence in food deserts with spinal fusion outcomes remains unknown. OBJECTIVES: We sought to investigate the association between living in a food desert and rates of reoperation and postoperative complications after long-segment lumbar fusion. METHODS: We retrospectively reviewed all adult patients at a single institution from 2011 to 2023 who underwent open long-segment (≥ 4 levels) lumbar spine fusion. Patient addresses linked with residence in a food desert as defined by the Economic Research Service. Multivariate logistic regressions were utilized to assess the association of food deserts with readmissions and reoperations. RESULTS: We identified 354 patients [median age at time of operation was 66 (IQR 59-72)] who met the inclusion criterion, of which 123 (35%) resided in a food desert. Patients in a food desert had higher neighborhood deprivation (80 vs 59, p < .001) and did not have differences in BMI (29.8 vs 29.9 p = .4). In multivariate regression analysis adjusting for frailty, clinical, socioeconomic, and operative characteristics, patients residing in a food desert had independently increased odds of re-operation within one year (OR 1.84, 95%CI 1.03-3.30) and readmission due to infection or wound breakdown (OR 3.09, 95%CI 1.03-10.1). Patients residing in a food desert were more likely to require reoperation for wound revision (8.9% vs 3.0%, p = .016) within one year. Using weighted survival analysis, patients who lived in a food desert had sooner times to reoperation (p = .045). CONCLUSIONS: Residence in a food desert may be a risk factor for reoperations following long segment lumbar spine surgery. Nutritional access may be an underlying driver of socioeconomic disparity impacting long-segment lumbar fusion.