{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T12:00:57Z","timestamp":1789214457396,"version":"build-2803163510"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the association between food insecurity and postoperative clinical outcomes in adult surgical trauma patients.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposures<\/jats:title>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.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>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).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2025.0045","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T16:01:40Z","timestamp":1741190500000},"page":"545","source":"Crossref","is-referenced-by-count":13,"title":["Food Insecurity and Clinical Outcomes in Surgical Trauma Patients"],"prefix":"10.1001","volume":"160","author":[{"given":"Anam N.","family":"Ehsan","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham & Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabelle","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham & Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivangi","family":"Saha","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Science, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preet","family":"Hathi","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Science, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaun-Chin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham & Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivasan","family":"Vengadassalapathy","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospital Chennai, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keerthana","family":"Bhat","sequence":"additional","affiliation":[{"name":"Ganga Medical Centres and Hospitals, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospital Chennai, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shashank","family":"Chauhan","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Science, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surya Rao Rao Venkata","family":"Mahipathy","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospital Chennai, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coral","family":"Katave","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham & Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Texas Tech University Health Sciences Center, El Paso, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maneesh","family":"Singhal","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Science, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth A.","family":"Berkowitz","sequence":"additional","affiliation":[{"name":"University of North Carolina School of Medicine, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Raja","family":"Sabapathy","sequence":"additional","affiliation":[{"name":"Ganga Medical Centres and Hospitals, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha","family":"Ranganathan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham & Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"soi250002r4","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/NUR.0000000000000794","article-title":"Food insecurity, neighborhood disadvantage, and hospital readmission in health system adults: a population health study.","volume":"38","author":"S Distelhorst","year":"2024","journal-title":"Clin Nurse Spec"},{"issue":"3","key":"soi250002r5","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1001\/jamainternmed.2023.7968","article-title":"Food insecurity and premature mortality and life expectancy in the US.","volume":"184","author":"Ma","year":"2024","journal-title":"JAMA Intern Med"},{"issue":"10","key":"soi250002r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.38677","article-title":"Evaluation of an intervention to address smoking and food insecurity at preoperative surgical clinic appointments.","volume":"5","author":"Lussiez","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"8","key":"soi250002r8","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.3390\/nu14081601","article-title":"Perioperative nutritional support: a review of current literature.","volume":"14","author":"Mart\u00ednez-Ortega","year":"2022","journal-title":"Nutrients"},{"issue":"5","key":"soi250002r9","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1097\/TA.0b013e3181ed4d29","article-title":"What are the true costs of major trauma?","volume":"70","author":"Rowell","year":"2011","journal-title":"J Trauma"},{"issue":"1","key":"soi250002r10","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1002\/nop2.620","article-title":"Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: a questionnaire study.","volume":"8","author":"Sveinsd\u00f3ttir","year":"2020","journal-title":"Nurs Open"},{"issue":"2","key":"soi250002r11","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.injury.2014.06.012","article-title":"Disability and depression after orthopaedic trauma.","volume":"46","author":"Nota","year":"2015","journal-title":"Injury"},{"issue":"8","key":"soi250002r12","doi-asserted-by":"publisher","first-page":"1801","DOI":"10.2106\/JBJS.E.00032","article-title":"Long-term persistence of disability following severe lower-limb trauma: results of a 7-year follow-up.","volume":"87","author":"MacKenzie","year":"2005","journal-title":"J Bone Joint Surg Am"},{"issue":"9","key":"soi250002r13","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1056\/NEJMp2313222","article-title":"Medically tailored meals to address the health consequences of food insecurity.","volume":"390","author":"Berkowitz","year":"2024","journal-title":"N Engl J Med"},{"issue":"10","key":"soi250002r14","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1097\/MLR.0000000000001759","article-title":"Effect of medically tailored meals on clinical outcomes in recently hospitalized high-risk adults.","volume":"60","author":"Go","year":"2022","journal-title":"Med Care"},{"key":"soi250002r19","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.annepidem.2019.01.014","article-title":"Assessing the relationship between food insecurity and mortality among US adults.","volume":"32","author":"Walker","year":"2019","journal-title":"Ann Epidemiol"},{"issue":"3","key":"soi250002r20","doi-asserted-by":"publisher","first-page":"E53","DOI":"10.1503\/cmaj.190385","article-title":"Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study.","volume":"192","author":"Men","year":"2020","journal-title":"CMAJ"},{"issue":"8","key":"soi250002r21","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1017\/S1368980017000180","article-title":"Brief assessment of food insecurity accurately identifies high-risk US adults.","volume":"20","author":"Gundersen","year":"2017","journal-title":"Public Health Nutr"},{"issue":"1","key":"soi250002r22","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.1542\/peds.2009-3146","article-title":"Development and validity of a 2-item screen to identify families at risk for food insecurity.","volume":"126","author":"Hager","year":"2010","journal-title":"Pediatrics"},{"issue":"4","key":"soi250002r23","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1097\/DCR.0000000000003073","article-title":"The association of food insecurity and surgical outcomes among patients undergoing surgery for colorectal cancer.","volume":"67","author":"Azap","year":"2024","journal-title":"Dis Colon Rectum"},{"issue":"4","key":"soi250002r24","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1007\/s00068-023-02264-2","article-title":"In-hospital complications after trauma due to road traffic accidents.","volume":"49","author":"Lopes","year":"2023","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"8","key":"soi250002r25","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1093\/ndt\/gfv071","article-title":"Analyzing hospitalization data: potential limitations of Poisson regression.","volume":"30","author":"Weaver","year":"2015","journal-title":"Nephrol Dial Transplant"},{"issue":"1","key":"soi250002r26","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/1472-6947-14-26","article-title":"Predicting length of stay from an electronic patient record system: a primary total knee replacement example.","volume":"14","author":"Carter","year":"2014","journal-title":"BMC Med Inform Decis Mak"},{"issue":"8","key":"soi250002r28","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.2001","article-title":"Interventions to Address food insecurity among adults in Canada and the US: a systematic review and meta-analysis.","volume":"2","author":"Oronce","year":"2021","journal-title":"JAMA Health Forum"},{"issue":"5","key":"soi250002r30","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1017\/ice.2023.67","article-title":"Strategies to prevent surgical site infections in acute-care hospitals: 2022 update.","volume":"44","author":"Calderwood","year":"2023","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"3","key":"soi250002r31","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1001\/jama.2022.24075","article-title":"Surgical site infection prevention: a review.","volume":"329","author":"Seidelman","year":"2023","journal-title":"JAMA"},{"issue":"1","key":"soi250002r32","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12889-018-6344-2","article-title":"Geographic and socio-demographic predictors of household food insecurity in Canada, 2011-2012.","volume":"19","author":"Tarasuk","year":"2019","journal-title":"BMC Public Health"},{"issue":"5","key":"soi250002r33","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1111\/ans.17675","article-title":"Disparities in surgical outcomes for low socioeconomic status patients in Australia.","volume":"92","author":"de Jager","year":"2022","journal-title":"ANZ J Surg"},{"issue":"5","key":"soi250002r34","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1001\/jamasurg.2013.5076","article-title":"Socioeconomic disparities in mortality after cancer surgery: failure to rescue.","volume":"149","author":"Reames","year":"2014","journal-title":"JAMA Surg"},{"issue":"8","key":"soi250002r35","doi-asserted-by":"publisher","first-page":"577","DOI":"10.7326\/M17-2441","article-title":"Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper.","volume":"168","author":"Daniel","year":"2018","journal-title":"Ann Intern Med"},{"issue":"1","key":"soi250002r36","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s12939-016-0458-x","article-title":"Cost of illness for outpatients attending public and private hospitals in Bangladesh.","volume":"15","author":"Pavel","year":"2016","journal-title":"Int J Equity Health"},{"issue":"2","key":"soi250002r37","doi-asserted-by":"publisher","first-page":"304","DOI":"10.3945\/jn.109.112573","article-title":"Food insecurity is associated with chronic disease among low-income NHANES participants.","volume":"140","author":"Seligman","year":"2010","journal-title":"J Nutr"},{"issue":"6","key":"soi250002r40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0179172","article-title":"Trends in food insecurity for adults with cardiometabolic disease in the US: 2005-2012.","volume":"12","author":"Berkowitz","year":"2017","journal-title":"PLoS One"},{"issue":"4","key":"soi250002r41","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.amjmed.2014.01.002","article-title":"Treat or eat: food insecurity, cost-related medication underuse, and unmet needs.","volume":"127","author":"Berkowitz","year":"2014","journal-title":"Am J Med"},{"issue":"3","key":"soi250002r42","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1007\/s11606-018-4716-z","article-title":"Medically tailored meal delivery for diabetes patients with food insecurity: a randomized cross-over trial.","volume":"34","author":"Berkowitz","year":"2019","journal-title":"J Gen Intern Med"},{"issue":"10","key":"soi250002r43","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1001\/jamasurg.2024.2570","article-title":"Strategies to mitigate food insecurity in patients undergoing surgery.","volume":"159","author":"Ehsan","year":"2024","journal-title":"JAMA Surg"},{"key":"soi250002r29","volume-title":"Global Guidelines for the Prevention of Surgical Site Infection","author":"World Health Organization","year":"2018","edition":"2nd ed"},{"key":"soi250002r1","unstructured":"Zereyesus? YA, Cardell? L. Global food insecurity grows in 2022 amid backdrop of higher prices, Black Sea conflict. Accessed September 16, 2024. https:\/\/www.ers.usda.gov\/amber-waves\/2022\/november\/global-food-insecurity-grows-in-2022-amid-backdrop-of-higher-prices-black-sea-conflict\/#:~:text=Overall%2C%20the%20number%20of%20food"},{"key":"soi250002r2","unstructured":"USDA Economic Research Service. Food security in the US\u2014measurement. Accessed September 16, 2024. https:\/\/www.ers.usda.gov\/topics\/food-nutrition-assistance\/food-security-in-the-u-s\/measurement"},{"key":"soi250002r3","unstructured":"PROOF UToronto. What are the implications of food insecurity for health and health care? Accessed September 16, 2024. https:\/\/proof.utoronto.ca\/food-insecurity\/what-are-the-implications-of-food-insecurity-for-health-and-health-care\/#:~:text=Adults%20in%20food%2Dinsecure%20households"},{"key":"soi250002r7","unstructured":"Fox? M. Social determinants of health and surgery: an overview. Accessed September 16, 2024. https:\/\/www.facs.org\/for-medical-professionals\/news-publications\/news-and-articles\/bulletin\/2021\/05\/social-determinants-of-health-and-surgery-an-overview\/#:~:text=Food%20insecurity%20is%20common%20in,is%20unavailable%20or%20prohibitively%20expensive."},{"key":"soi250002r15","unstructured":"Ministry of Education, Government of India. National institutional ranking framework. Accessed February 4, 2025. https:\/\/www.nirfindia.org\/Rankings\/2024\/MedicalRanking.html"},{"key":"soi250002r16","unstructured":"Ganga Medical Centre & Hospitals Pvt Ltd. FNB trauma surgery. Accessed February 4, 2025. https:\/\/www.gangahospital.com\/program\/5"},{"key":"soi250002r17","unstructured":"Ganga Medical Centre & Hospitals Pvt Ltd. Trauma and accident surgery. Accessed February 4, 2025. https:\/\/www.gangahospital.com\/super-speciality\/trauma-and-accident-surgery"},{"key":"soi250002r18","unstructured":"US Department of Veterans Affairs. VHA Invasive procedure complexity for surgical programs. Accessed February 4, 2025. https:\/\/www.va.gov\/health\/surgery\/"},{"key":"soi250002r27","unstructured":"Mueller? PS. Food insecurity is associated with higher risk for premature death and shorter life expectancy in US adults. Accessed September 16, 2024. https:\/\/www.jwatch.org\/na57078\/2024\/02\/13\/food-insecurity-associated-with-higher-risk-premature"},{"key":"soi250002r38","unstructured":"Gregory? CA, Coleman-Jensen? A. Food insecurity, chronic disease, and health among working-age adults. Accessed February 4, 2025. https:\/\/www.ers.usda.gov\/publications\/pub-details?pubid=84466"},{"key":"soi250002r39","unstructured":"Berkowitz? SA, Seligman? HK, Basu? S. Impact of food insecurity and SNAP participation on healthcare utilization and expenditures. Accessed September 16, 2024. https:\/\/uknowledge.uky.edu\/ukcpr_papers\/103\/"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2830865\/jamasurgery_ehsan_2025_oi_250002_1747170536.22165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T15:03:33Z","timestamp":1747235013000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2830865"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":43,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2025.0045","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}