Piuzzi Nicolas S, George Jaiben, Khlopas Anton, Klika Alison K, Mont Michael A, Muschler George F, Higuera Carlos A
Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Ann Transl Med. 2018 Aug;6(16):321. doi: 10.21037/atm.2018.08.21.
High rates of vitamin D insufficiency and deficiency have been demonstrated in various patient populations, including patients undergoing total joint arthroplasties (TJA). However, the risk factors associated with this condition and its seasonal variation is still to be determined in patients scheduled for elective TJA.
We retrospectively identified 226 (116 hips, 120 knees) patients who underwent primary TJA, and had a vitamin D measurement, at a single institution (latitude, 41° 30' N) from 2006 to 2016. Demographics, comorbidities, and perioperative data were collected from electronic medical records. Patients were stratified into vitamin D sufficient (≥30 ng/mL), insufficient (<30 ng/mL), and deficient group (<20 ng/mL). Multivariate regression analyses were used to study the risk factors for vitamin D insufficiency and deficiency.
There were 99/226 (43.8%) patients in the vitamin D sufficient group, 137/226 patients (60.6%) in the insufficient group, of which 61/226 (26.9%) were in the deficient group. On multivariate analysis, an American Society of Anesthesiologists' (ASA) score ≥3 was a risk factor for vitamin D insufficiency (P<0.001), while ASA ≥3 (P<0.001) and younger age (P=0.002) were risk factors for vitamin D deficiency. Vitamin D levels varied between the quarters with lowest level seen in quarter 1 (P=0.015).
There was an overall high prevalence of vitamin D insufficiency (60%) and deficiency (27%). Due to higher risk of hypovitaminosis D, particular attention should be placed in patients with an ASA score ≥3, and patients scheduled during winter season.
在包括接受全关节置换术（TJA）的患者在内的各种患者群体中，已证实维生素D不足和缺乏的发生率很高。然而，择期TJA患者中与这种情况相关的危险因素及其季节性变化仍有待确定。
我们回顾性确定了2006年至2016年在单一机构（北纬41°30'）接受初次TJA并进行维生素D测量的226例患者（116例髋关节，120例膝关节）。从电子病历中收集人口统计学、合并症和围手术期数据。患者被分为维生素D充足（≥30 ng/mL）、不足（<30 ng/mL）和缺乏组（<20 ng/mL）。采用多因素回归分析研究维生素D不足和缺乏的危险因素。
维生素D充足组有99/226例（43.8%）患者，不足组有137/226例（60.6%）患者，其中缺乏组有61/226例（26.9%）患者。多因素分析显示，美国麻醉医师协会（ASA）评分≥3是维生素D不足的危险因素（P<0.001），而ASA≥3（P<0.001）和年龄较小（P=0.002）是维生素D缺乏的危险因素。维生素D水平在各季度有所不同，第一季度水平最低（P=0.015）。
维生素D不足（60%）和缺乏（27%）的总体患病率较高。由于维生素D缺乏症风险较高，应特别关注ASA评分≥3的患者以及在冬季安排手术的患者。
