Preoperative Vitamin D Deficiency Is Associated With Postoperative Delirium in Critically Ill Patients
J Intensive Care Med . 2021 Jul 1;8850666211021330. doi: 10.1177/08850666211021330
Yuwei Qiu 1 2, Daniel I Sessler 1, Liang Chen 1 3, Sven Halvorson 1 3, Barak Cohen 1, Mauro Bravo 1, Ilker Ince 1 4, Kamal Maheshwari 1 5, Andrea Kurz 1 5
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- Off topic: Improving your health BEFORE surgery (prehabilitation) helps your recovery - 2018
- Surgeries outcomes far better if daily 50,000 IU of vitamin D for a week – Oct 2018
- Give Vitamin D before all spinal surgeries – no testing needed – June 2020
- Surgery outcome worse if low vitamin D (lumbar spine surgery this time) – Nov 2019
- Spinal Surgery patients – almost all have low vitamin D – Nov 2016
- Vitamin D needed after most spinal surgeries (and before as well) – 2013
- Half as many problems if take Vitamin D (300,000 IU) before thyroid surgery – RCT Jan 2021
- Vitamin D before surgery often helps (Thyroidectomy in this case) – Sept 2019
- Pre-operative Vitamin D often helps (thyroidectomy in this case) – June 2021
Introduction: Postoperative delirium is common, with a reported incidence of 11% to 80% in critically ill patients. Delirium is an independent prognostic factor for poor hospital outcomes. Low vitamin D concentrations are associated with a decline in cognitive function. We therefore tested the hypothesis that low preoperative serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with postoperative delirium in critically ill patients.
Method: We conducted a retrospective analysis of adults in a surgical intensive care unit for at least 48 hours immediately after non-cardiac and non-neurosurgical operations at Cleveland Clinic between 2013 and 2018. Delirium was assessed by trained nurses using CAM-ICU twice daily for the initial 5 postoperative days. Any positive value was considered evidence of delirium. We assessed the association between 25(OH)D concentrations within a year before surgery and the incidence of postoperative delirium using logistic regression, adjusted for potential confounders. A linear spline term with a knot at 30 ng/ml, the threshold for normal 25(OH)D concentration, was added to accommodate a nonlinear relationship between 25(OH)D concentrations and delirium.
Results: We included 632 patients, who had a mean (SD) 25(OH)D concentration of 25 (15) ng/ml; 55% (346/632) experienced delirium. We observed an adjusted odds ratio of 1.4 (95% CI: [1.1, 1.8], P = 0.01) for delirium per 10 ng/ml decrease in 25(OH)D concentrations when patients' 25(OH)D concentrations were less than 30 ng/ml. In patients whose 25(OH)D concentrations were at least 30 ng/ml, the adjusted odds ratio was 0.9 (95% CI: [0.7, 1.1], P = 0.36).
Conclusion: Preoperative 25(OH)D concentrations are associated with postoperative delirium in patients whose concentrations are below the normal threshold, but not at concentrations ≥30 ng/ml. A trial will be needed to determine whether the relationship is causal, and whether vitamin D supplementation before surgery might reduce the incidence of delirium.
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