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Chance of death after non-cardiac surgery reduced 2X by Vitamin D – Aug 2014

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

Anesth Analg. 2014 Aug 13. [Epub ahead of print]
Turan A1, Hesler BD, You J, Saager L, Grady M, Komatsu R, Kurz A, Sessler DI.
1From the Departments of *Outcomes Research, †Quantitative Health Sciences and Outcomes Research, and ‡Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.

VitaminDWiki Summary

7% less likely to die for every extra 5 ng of vitamin D

Odds ratio for deathVitamin D level
1.0 < 13 ng
0.65 13-20 ng
0.53 20-27 ng
0.44 27-36 ng
0.49 > 36 ng


BACKGROUND::
Vitamin D deficiency is a global health problem. Epidemiological studies demonstrate that vitamin D is both cardioprotective and neuroprotective. Vitamin D also plays a substantial role in innate and acquired immunity. Our goal was to evaluate the association of serum vitamin D concentration on serious postoperative complications and death in noncardiac surgical patients.
METHODS::
We retrospectively analyzed the data of 3509 patients who had noncardiac surgery at the Cleveland Clinic Main Campus and had a serum vitamin D measurement. The relationship between serum vitamin D concentration and all-cause in-hospital mortality, in-hospital cardiovascular morbidity, and serious in-hospital infections was assessed as a common effect odds ratio (OR) by using a multivariate generalized estimating equation model with adjustment for demographic, medical history variables, and type and duration of surgery.
RESULTS::
Higher vitamin D concentrations were associated with decreased odds of in-hospital mortality/morbidity (P = 0.003). There was a linear reduction of the corresponding common effect odds ratio (OR 0.93, 95% confidence interval, 0.88-0.97) for severe in-hospital outcomes for each 5 ng/mL increase in vitamin D concentration over the range from 4 to 44 ng/mL. In addition, we found that the odds versus patients with vitamin D <13 ng/mL (i.e., 1st quintile) were significantly lower in patients with vitamin D 13-20, 20-27, 27-36, and > 36 ng/mL (i.e., 2nd-5th quintiles); the corresponding estimated ORs were 0.65 (99% confidence interval, 0.43-0.98), 0.53 (0.35-0.80), 0.44 (0.28-0.70), and 0.49 (0.31-0.78), respectively. However, there was no statistically significant difference among individual quintiles >13 ng/mL.
CONCLUSIONS::
Vitamin D concentrations were associated with a composite of in-hospital death, serious infections, and serious cardiovascular events in patients recovering from noncardiac surgery. While causality cannot be determined from our retrospective analysis, the association suggests that a large randomized trial of preoperative vitamin D supplementation and postoperative outcomes is warranted.

PMID: 25121616


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