Vitamin D is needed before most surgeries – many studies and RCTs

Summary recommendations

1. Loading doses of 300,000 IU Vitamin D have been frequently used for adults
   More than 300,000 IU is sometimes needed for adults
   infants-Children might only need 10,000 IU per kg
2. Loading dose can spread out over a week or given in a single day
   Surgery should not occur for several days after an oral loading dose
   Surgery should not occur for several weeks after a Vitamin D Injection
3. A gut-friendly form of Vitamin D should be used if patient has poor digestion
   if the surgery is an emergency, then fast-acting form of vitamin D should be used
   Nanoemulsion sublingual or on skin will raise the Vitamin D level in <12 hours
4. All of the above also applies to ICU (Intensive Care Unit)
5. Vitamin D3, not Vitamin D2 should be used
6. Note: Some Chemotherapy might be amplified by vitamin D. could result in death if chemo dose cannot be decreased

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20+ studies: Much better outcome if add Vitamin D before/after surgery

• Orthopaedic surgeries need Vitamin D – many studies
• Better Surgical outcomes if preceded by Vitamin D loading dose – Oct 2018
• Little risk of infection after surgery if have more than 50 ng of vitamin D - 2014
• Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
• Esophageal Cancer surgery helped by 300,000 IU of Vitamin D – RCT Sept 2018
• Surgeries more successful if high vitamin D (tympanic membrane in this case) – Nov 2022

Heart

• Taking Vitamin D just before and after surgery helps (open-heart in this case) – RCT Feb 2021
• Half as much AFIB after bypass if 600,000 IU of vitamin D before surgery – RCT April 2022
• Getting Vitamin D before heart surgery prevented Afib in those who had been deficient – July 2018

Bone

• Foot and Ankle Surgeries should benefit from Vitamin D – Feb 2019
• Spinal Fusion complications 2.2 X more likely if low Vitamin D – Dec 2020

Brain

• Surgeries to re-establish blood in brain, heart, etc. are far more successful with high Vitamin D levels – March 2022
• Fewer days in hospital if 300,000 IU of vitamin D before brain surgery - RCT Feb 2021
• Traumatic Brain Injury – 120,000 IU of Vitamin D resulted in 3 fewer days on ventilators – RCT March 2020

Sepsis

• 3X less Septic Shock in children with sepsis getting 150,000 IU of Vitamin D - RCT June 2020
• Severe sepsis may be prevented by 400,000 IU of vitamin D – RCT 2023
• Urinary sepsis – a single Vitamin D injection reduced hospital days by 40 percent – RCT April 2018

Thyroid

• Half as many problems if take Vitamin D (300,000 IU) before thyroidectomy – RCT Jan 2021
• Pre-operative Vitamin D often helps (thyroidectomy in this case) – June 2021
• Vitamin D before surgery often helps (Thyroidectomy in this case) – Sept 2019

11+ studies: improved ICU outcomes

• 18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016
• Fewer days in ICU after 300,000 IU of vitamin D, but not 540,000 – meta-analysis Aug 2020
• Heart attack ICU costs cut in half by Vitamin D – Oct 2018
• Hospital ICU added high dose vitamin D - malpractice lawsuit costs dropped from 26 million dollars to ZERO - Oct 2016
• ICU adults getting 540,000 IU of Vitamin D were 2X more likely to be alive 30 days later – RCT June 2019
• ICU cost reduced by at least 27,000 dollars if get high dose vitamin D in first week - April 2017
• ICU mortality reduced by non-oral vitamin D – meta-analysis May 2021
• ICU patients greatly helped by Vitamin D loading doses – if gut-friendly – Oct 2020
• ICU survival increased with vitamin D single 540K IU loading dose - JAMA Sept 2014
• Those getting an injection of 300,000 IU Vitamin D got out of the ICU a week sooner – RCT Dec 2020
• Vitamin D loading doses reduce ICU mortality by 30 percent – meta-analysis April 2017

15+ studies: Poor surgery outcomes if low vitamin D

• Surgery outcome worse if low vitamin D (lumbar spine surgery this time) – Nov 2019
• Postoperative cognitive dysfunction 8 X more likely if low vitamin D – March 2018
• 3 additional hospital days after emergency neurosurgery if low vitamin D – Nov 2019
• Surgical Site Infection 4X more likely if low vitamin D – Aug 2019
• 40% less likely to recover from TBI with Intracranial Injury if low vitamin D – June 2022
• Crohn's Disease 4X less likely to reoccur after surgery if good level of vitamin D – Feb 2021
• Delirium or cognitive problems after surgery 1.5X more likely if low vitamin D –meta-analysis Aug 2022
• Kidney transplant rejection 1.8X more likely if low vitamin D – May 2021
• Low vitamin D at ICU admission is associated with cancer, infections, acute respiratory insufficiency and liver failure – Oct 2018
• More post-operative pain if low vitamin D before ( 2.4 X for Thoracoscopic) – Oct 2022
• Spinal Fusion complications 2.2 X more likely if low Vitamin D – Dec 2020
• Spinal Surgery patients – almost all have low vitamin D – Nov 2016
• Surgery outcome worse if low vitamin D (lumbar spine surgery this time) – Nov 2019
• Trauma with fracture – 2 weeks longer hospital stay if less than 10 ng vitamin D – Jan 2018
• Vitamin D deficiency with severe sepsis increased risk of dying by 7.7 X – Nov 2017

4+ studies: Surgeries reduce vitamin D Levels

• Critical illness – Vitamin D levels start low and then drop for several days – Feb 2018
• Vitamin D levels crash after various surgeries (cardiac in this case) – Nov 2021
• After hip surgery Vitamin D levels dropped by 32 percent – Sept 2018
• Surgeries often deplete Vitamin D - 300,000 IU resulted in little response – Nov 2018
• Pro-inflammatory cytokines cause the 74 percent drop in vitamin D after knee arthroplasty – Feb 2014

5+ suggestions for Vitamin D before/after surgery

• Vitamin D appears essential to survive many critical illnesses - review Oct 2018
• Give Vitamin D before all spinal surgeries – no testing needed – June 2020
• Vitamin D needed after most spinal surgeries (and before as well) – 2013
• Foot and Ankle Surgeries should benefit from Vitamin D – Feb 2019
• Use of Vitamin D in a trauma surgery - Dr. Matthews on Facebook – Jan 2020

20X fewer problems after surgery (noncardiac) if high level of Vitamin D

The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery- 2014
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