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Food Insecurity is Associated with Poor Outcomes After Revascularization for Chronic Limb Threatening Ischemia
Thomas McNamara1, Max Zhu1, Diana Rodriguez1, Nkiruka Arinze1, Thomas W. Cheng1, Alik Farber1, Elizabeth G. King1, Andrea Alonso1, Jeffrey J. Siracuse1
1Divison of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA, 2Boston University Chobanian & Avedisian School of Medicine, Boston MA

Background: Social determinants of health (SDH) challenges have been associated with poor surgical outcomes. One aspect which has been poorly characterized is food insecurity. Our goal was to assess the association of food insecurity with outcomes after lower extremity revascularization for chronic limb threatening ischemia (CLTI).
Methods: A retrospective, single center review of patients presenting for a lower extremity revascularization (2018-2022) at a safety-net, tertiary hospital was conducted. Patients were classified as experiencing food insecurity, if self-reported on a SDH screen, or had a food pantry referral within one year. Univariable and multivariable analyses were performed.
Results: There were 299 patients analyzed with 17% reporting food insecurity. Overall, interventions were 31% open, 8% hybrid, and 61% endovascular revascularization. On multivariable analysis, younger age (OR .96, 95% CI .92-.99, P=.02) and African American race (OR 3.8, 95% CI 1.4-10.3, P=.01) were associated with food insecurity. Poor outcomes in food insecure patients were evident in both open and endovascular procedures (Table 1). For 1-year outcomes, food insecurity was independently associated with increased ED visits (OR 6.4, 95% CI 1.8-22.6, P=.004), readmissions (OR 4.2, 95% CI 1.5-11.6, P=.005), and increased risk of amputation (HR 2.5, 95% CI 1.3-4.8, P=.005).
Conclusion: Food insecurity was common in our population of CLTI patients and was associated with higher readmissions and major amputations. Addressing this is in these high-risk patients is an area for targeted improvement.
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