Hung Kuo-Chuan, Yu Ting-Sian, Liao Shu-Wei, Lai Yi-Chen, Fu Pei-Han, Feng Ping-Hsun, Chen I-Wen
Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
Front Nutr. 2025 Jul 17;12:1617670. doi: 10.3389/fnut.2025.1617670. eCollection 2025.
To assess the impact of preoperative vitamin D deficiency (VDD) on the risk of postoperative delirium (POD) in patients undergoing musculoskeletal surgery.
This cohort study utilized the TriNetX Healthcare Commercial Organizations database. We included patients aged 50 years or older who underwent musculoskeletal surgery requiring hospital admission. Patients were categorized according to their preoperative vitamin D levels into three groups: deficient (≤20 ng/mL), insufficient (21-29 ng/mL), and sufficient (≥30 ng/mL). The primary outcome was POD within 30 days of surgery. Secondary outcomes included risks of surgical site infections, emergency department (ED) visits, and intensive care unit (ICU) admissions. Risk factors for POD were assessed using multivariate logistic regression analysis.
After matching, 6,218 pairs of vitamin D-deficient and sufficient patients were compared. VDD was related to a significantly higher risk of POD [1.0% vs. 0.5%; odds ratio (OR): 2.18, 95% confidence interval (CI): 1.41-3.36, < 0.001]. Vitamin D-deficient patients also had higher rates of ED visits (OR: 1.36, 95% CI: 1.18-1.57, < 0.001) and ICU admissions (OR: 1.51, 95% CI: 1.19-1.91, < 0.001). Similarly, vitamin D insufficiency (10,764 matched pairs) was associated a smaller but significant increase in delirium risk (OR: 1.49, 95%CI: 1.05-2.12, = 0.023), along with increased ED visits (OR: 1.16, 95% CI: 1.03-1.30, = 0.013) and ICU admissions (OR: 1.25, 95% CI: 1.03-1.52, = 0.0261), suggesting a dose-dependent relationship. Risk factor analysis revealed that advanced age, male sex, chronic kidney disease, and malnutrition were significant predictors of POD in patients with VDD.
Individuals with VDD experienced a higher risk of POD, suggesting the potential benefits of preoperative vitamin D screening and supplementation as a strategy to improve outcomes in surgical patients. While our findings highlight the potential benefit of vitamin D assessment and optimization before surgery, the retrospective design limits the ability to draw causal inferences. Prospective interventional studies are warranted to determine whether treating VDD can meaningfully lower the risk of POD.
评估术前维生素D缺乏（VDD）对接受肌肉骨骼手术患者术后谵妄（POD）风险的影响。
这项队列研究使用了TriNetX医疗商业组织数据库。我们纳入了年龄在50岁及以上、因肌肉骨骼手术需要住院的患者。根据术前维生素D水平将患者分为三组：缺乏（≤20 ng/mL）、不足（21 - 29 ng/mL）和充足（≥30 ng/mL）。主要结局是术后30天内发生POD。次要结局包括手术部位感染、急诊就诊和重症监护病房（ICU）入院的风险。使用多因素逻辑回归分析评估POD的危险因素。
匹配后，比较了6218对维生素D缺乏和充足的患者。VDD与POD风险显著升高相关[1.0%对0.5%；比值比（OR）：2.18，95%置信区间（CI）：1.41 - 3.36，P < 0.001]。维生素D缺乏的患者急诊就诊率（OR：1.36，95% CI：1.18 - 1.57，P < 0.001）和ICU入院率（OR：1.51，95% CI：1.19 - 1.91，P < 0.001）也更高。同样，维生素D不足（10764对匹配患者）与谵妄风险虽较小但显著增加相关（OR：1.49，95% CI：1.05 - 2.12，P = 0.023），同时急诊就诊增加（OR：1.16，95% CI：1.03 - 1.30，P = 0.013）和ICU入院增加（OR：1.25，95% CI：1.03 - 1.52，P = 0.0261），提示存在剂量依赖关系。危险因素分析显示，高龄、男性、慢性肾脏病和营养不良是VDD患者发生POD的显著预测因素。
VDD患者发生POD的风险更高，这表明术前维生素D筛查和补充作为改善手术患者结局的策略具有潜在益处。虽然我们的研究结果突出了术前维生素D评估和优化的潜在益处，但回顾性设计限制了得出因果推断的能力。有必要进行前瞻性干预研究以确定治疗VDD是否能有效降低POD风险。
