Living in a Food Desert is Associated With Increased Wound Complications After Major Vascular Procedures

Abstract

Food deserts (FDs) are regions that lack grocery stores, have unaffordable healthy options, and/or have a density of poor-quality food choices. Living in a FD has been associated with metabolic risks; however, its relationship to wound complications after major vascular surgery remains unexplored. We hypothesized that FD status would be associated with an increased incidence of wound complications after major vascular surgery. We performed a single-center retrospective analysis of open vascular procedures from 2012 to 2020. FD status was determined by matching the patient census tract location to low- income and low-food access metrics from the U.S. Department of Agriculture Food Access Research Atlas. Major vascular procedures included infrainguinal bypass, femoral endarterectomy, aortofemoral bypass grafting, lower extremity bypass, open abdominal aortic aneurysm repair, and thoracoabdominal aortic repair. The Area Deprivation Index (ADI), a validated marker of socioeconomic status, was used to distinguish the effects of FD status from other markers of social disadvantage such as education and housing. Multivariable logistic regression was used to assess the independent association of FD status with wound complications. Among 1417 patients, 119 (8%) resided in a FD. Overall, wound complications occurred in 124 patients (9%): 15%, femoral endarterectomy; 14%, aortofemoral bypass grafting; 13%, infrainguinal bypass; 10%, thoracoabdominal aortic aneurysm repair; and 4%, open abdominal aortic aneurysm repair (P < .01). Patients in an FD were younger (61 vs 67 years; P < .01), more frequently had chronic obstructive pulmonary disease (28% vs 17%; P = .02), and had twice the incidence of wound complications (24% vs 12%; P < .01). On multivariable analysis, FD status was independently associated with increased odds of wound complications (1.9; 95% confidence interval 1.0-3.5; P = .04; Table). On sensitivity analysis, FD status and diabetes interacted, and FD and diabetes combined resulted in a 2.8-fold increased odds (95% confidence interval, 1.1-7.0) of wound complications compared with those without either risk factor. Living in a FD was associated with twice the odds of wound complications after major vascular operations. These results suggest that food insecurity can affect wound healing and should be considered as a potential modifiable perioperative risk factor. Future study of interventions aimed at addressing access to healthy foods is warranted.TableMultivariable analysis of wound complicationsCovariateaORa95% CIP valueFood desert1.91.0-3.5.04Obesity1.61.0-2.5.03CAD1.71.1-2.6.01Area deprivation indexb Medium1.71.0-2.9.03 High1.30.7-2.2.42aOR, Adjusted odds ratio; CAD, coronary artery disease; CI, confidence interval.Boldface P values represent statistical significance.aAdjusted for age ≥70 years, diabetes mellitus, coronary artery disease, area deprivation index, chronic obstructive pulmonary disease, obesity, aspirin, postoperative red blood cell transfusion, chronic kidney disease stage 5, operative indication, and procedure type.bCompared with an area deprivation index reference group of low. Open table in a new tab