The Association of Food Insecurity and Surgical Outcomes Among Patients Undergoing Surgery for Colorectal Cancer

Abstract

BACKGROUND: Food insecurity predisposes individuals to suboptimal nutrition, leading to chronic disease and poor outcomes. OBJECTIVE: We sought to assess the impact of county-level food insecurity on colorectal surgical outcomes. DESIGN: Retrospective cohort study. SETTING: SEER-Medicare database merged with county-level food insecurity obtained from the Feeding America: Mapping the Meal Gap report. Multiple logistic and Cox regression adjusted for patient-level covariates were implemented to assess outcomes. PATIENTS: Medicare beneficiaries diagnosed with colorectal cancer between 2010 and 2015. MAIN OUTCOME MEASURES: Surgical admission type (nonelective and elective admission), any complication, extended length-of-stay, discharge disposition (discharged to home and non-home discharge), 90-day readmission, 90-day mortality, and textbook outcome. Textbook outcome was defined as no extended length-of-stay, post-operative complications, 90-day readmission, and 90-day mortality. RESULTS: Among 72,354 colorectal cancer patients, 46,296 underwent resection. Within the surgical cohort, 9,091 (19.3%) were low, 27,716 (59.9%) were moderate, and 9,489 (20.5%) were high food insecurity. High food insecurity patients had greater odds of nonelective surgery (OR: 1.17, 95% CI: 1.09-1.26, p < 0.001), 90-day readmission (OR: 1.11, 95% CI: 1.04-1.19, p = 0.002), extended length-of-stay (OR: 1.32, 95% CI: 1.21-1.44, p < 0.001), and complications (OR: 1.11, 95% CI: 1.03-1.19, p = 0.002). High food insecurity patients also had decreased odds of home discharge (OR: 0.85, 95% CI: 0.79-0.91, p < 0.001) and textbook outcomes (OR: 0.81, 95%CI: 0.75-0.87, p < 0.001). High food insecurity minority patients had increased odds of complications (OR 1.59, 95% CI, 1.43-1.78) and extended length-of-stay (OR 1.89, 95% CI, 1.69-2.12) when compared with low food insecurity White individuals (all, p < 0.001). Notably, high food insecurity minority patients had 31% lower odds of textbook outcomes (OR: 0.69, 95% CI, 0.62-0.76, p < 0.001) compared with low food insecurity White patients (p < 0.001). LIMITATIONS: Limited to Medicare beneficiaries aged ≥65 years, hence may not be generalizable to younger populations or those with uninsurance/private insurance. CONCLUSIONS: County-level food insecurity was associated with suboptimal outcomes, demonstrating the importance of interventions to mitigate these inequities