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Vitamin D

Low vitamin D levels linked to increased risks after surgery

Most patients did not meet the recommended 25-hydroxyvitamin D concentration of greater than 30ng/mL
The association with low vitamin D was statistically significant only for cardiovascular complications, although there were "strong trends" for mortality and infections

Patients with low blood levels of vitamin D are at increased risk of death and serious complications after non-cardiac surgery, according to a study published in Anesthesia & Analgesia. They believe their results warrant further study to see if giving vitamin D supplementation before surgery can reduce the risk of these adverse outcomes.

The researchers note that epidemiological studies demonstrate that vitamin D is both cardioprotective and neuroprotective and that vitamin D also plays a substantial role in innate and acquired immunity. Therefore, they wanted to evaluate the association of serum vitamin D concentration on serious postoperative complications and death in non-cardiac surgical patients.

The researchers analysed the relationship between vitamin D level and surgical outcomes in 3,509 patients non-cardiac surgery at the Cleveland Clinic Main Campus and had a serum vitamin D measurement between 2005 and 2011. Only patients who had available data on vitamin D levels around the time of surgery (from three months before to one month afterward) were included in the study.

The concentration of vitamin D (specifically, 25-hydroxyvitamin D) in blood samples was analyzed as a risk factor for death, cardiovascular events, or serious infections while in the hospital. The analysis included adjustment for other factors such as demographic characteristics, medical conditions, and type and duration of surgery.

They found that most patients did not meet the recommended 25-hydroxyvitamin D concentration of greater than 30 nanograms per milliliter (ng/mL). The median vitamin D level was 23.5ng/mL - more than 60 percent of patients were in the range of vitamin D insufficiency (10 to 30ng/mL). Nearly 20 percent had vitamin D deficiency (less than 10ng/mL).

"Higher vitamin D concentrations were associated with decreased odds of in-hospital mortality/morbidity," the researchers write.

For each 5ng/mL increase in 25-hydroxyvitamin D level, the combined risk of death, cardiovascular events, or serious infections decreased by seven percent.

Patients at the lowest level of 25-hydroxyvitamin D (less than 13ng/mL) were at highest risk of death or serious complications. Those with higher vitamin D levels (up to 44ng/mL) had about half the risk as those in the lowest group. The association with low vitamin D was statistically significant only for cardiovascular complications, although there were "strong trends" for mortality and infections.

However, Turan and colleagues note that their study had some important limitations of their study, especially the fact that it included only patients who had recent measurements of vitamin D levels. They may represent a less-healthy group, introducing a potential source of selection bias.

The study cannot determine whether there is any cause-and-effect relationship between vitamin D levels and the risk of adverse outcomes, and the researchers suggest a randomised trial could effectively evaluate whether preoperative vitamin D supplementation can reduce the risk of serious complications and death after surgery.

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