Ehsan Anam N, Jones Annabelle, Saha Shivangi, Hathi Preet, Huang Chaun-Chin, Vengadassalapathy Srinivasan, Bhat Keerthana, Ganesh Praveen, Chauhan Shashank, Mahipathy Surya Rao Rao Venkata, Katave Coral, Singhal Maneesh, Berkowitz Seth A, Sabapathy S Raja, Ranganathan Kavitha
Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham & Women's Hospital, Boston, Massachusetts.
All India Institute of Medical Science, New Delhi, Delhi, India.
JAMA Surg. 2025 May 1;160(5):545-552. doi: 10.1001/jamasurg.2025.0045.
Food insecurity, which is the lack of consistent access to sufficient and nutritious food, impacts over 1.3 billion individuals worldwide. The impact of food insecurity on primary care and medical subspecialties is recognized, but its influence on surgical outcomes remains underexplored.
To investigate the association between food insecurity and postoperative clinical outcomes in adult surgical trauma patients.
DESIGN, SETTING, AND PARTICIPANTS: This prospective longitudinal cohort study was conducted from October 2021 to June 2023 and surveyed patients at admission and at 1 and 3 months postoperatively. This multicenter study was conducted across 3 public and private tertiary care centers in India. Adult patients who underwent inpatient operative intervention for traumatic injury were included through consecutive sampling.
Food insecurity, which was identified using the validated Hunger Vital Sign tool. This was determined at admission as preoperative food insecurity. Also assessed was a subset of participants who were food secure at admission but then became food insecure during the follow-up period.
Postoperative complications and length of stay. These outcomes were tracked during hospitalization and also at 1 month and 3 months after discharge to compare between time points.
A total of 848 patients (median [IQR] age, 32 [24-45] years; 692 male [82%]) were included in this analysis. Of the total cohort, 174 participants (21%) reported experiencing food insecurity in the year before admission. Patients with food insecurity had significantly higher rates of postoperative complications compared with those without food insecurity (41.4% [72 of 174] vs 12.5% [84 of 671]; odds ratio [OR], 3.68; 95% CI, 2.24-6.05). Additionally, patients with food insecurity had a longer median (IQR) length of stay (13 [6-28] days vs 5 [3-9] days; incidence rate ratio, 1.51; 95% CI, 1.31-1.74). Furthermore, new-onset food insecurity at 1 month postoperatively was associated with an increased risk of new complications at 3 months postoperatively (OR, 5.06; 95% CI, 2.21-11.13).
Results demonstrate that food insecurity was significantly associated with increased postoperative complications and longer hospital stays in surgical trauma patients. Routine screening for food insecurity and targeted interventions like medically tailored meals, food prescription programs, and philanthropic food resources may mitigate the detrimental impact of food insecurity on surgical outcomes.
粮食不安全，即无法持续获得充足且营养丰富的食物，影响着全球超过13亿人。粮食不安全对初级保健和医学专科的影响已得到认可，但其对外科手术结果的影响仍未得到充分研究。
探讨成人外科创伤患者粮食不安全与术后临床结果之间的关联。
设计、背景和参与者：这项前瞻性纵向队列研究于2021年10月至2023年6月进行，在患者入院时以及术后1个月和3个月进行调查。这项多中心研究在印度的3家公立和私立三级医疗中心开展。通过连续抽样纳入因创伤性损伤接受住院手术干预的成年患者。
使用经过验证的饥饿生命体征工具确定粮食不安全情况。在入院时确定为术前粮食不安全。还评估了一部分入院时粮食安全但在随访期间出现粮食不安全的参与者。
术后并发症和住院时间。在住院期间以及出院后1个月和3个月跟踪这些结局，以便在不同时间点进行比较。
本分析共纳入848例患者（年龄中位数[四分位间距]为32[24 - 45]岁；692例男性[82%]）。在整个队列中，174名参与者（21%）报告在入院前一年经历过粮食不安全。与没有粮食不安全的患者相比，粮食不安全的患者术后并发症发生率显著更高（41.4%[174例中的72例]对12.5%[671例中的84例]；优势比[OR]为3.68；95%置信区间[CI]为2.24 - 6.05）。此外，粮食不安全的患者住院时间中位数（四分位间距）更长（13[6 - 28]天对5[3 - 9]天；发病率比为1.51；95%CI为1.31 - 1.74）。此外，术后1个月出现新发粮食不安全与术后3个月出现新并发症的风险增加相关（OR为5.06；95%CI为2.21 - 11.13）。
结果表明，粮食不安全与外科创伤患者术后并发症增加和住院时间延长显著相关。对粮食不安全进行常规筛查以及开展针对性干预措施，如根据医学定制的膳食、食物处方计划和慈善食物资源，可能会减轻粮食不安全对外科手术结果的不利影响。
