Perioperative Medicine  |   January 2020
Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity after Noncardiac Surgery
Author Notes
  • From the Department of Outcomes Research (A.T., A.S.A., C.H., P.S., K.M., A.K., K.R., D.I.S.), and Department of General Anesthesiology (A.T., K.M., A.K., K.R.), Anesthesiology Institute, and the Department of Quantitative Health Sciences (A.S.A.), Cleveland Clinic, Cleveland, Ohio; the Department of Health Research Methods, Evidence, and Impact (P.J.D., E.D.), and the Department of Medicine (A.P., M.T.), McMaster University, Hamilton, Canada; the Population Health Research Institute, Hamilton, Canada (P.J.D., E.D.); Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (R.P.); the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (M.T.V.C., W.K.K.W.); the Department of Surgery, University of Manitoba, Winnipeg, Canada (S.S.); the Department of Medicine, Western University, London, Canada (A.X.G.); and the Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom (R.S.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication November 30, 2018. Accepted for publication August 23, 2019.
    Submitted for publication November 30, 2018. Accepted for publication August 23, 2019.×
  • Address correspondence to Dr. Turan: Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, P-77, Cleveland, Ohio, 44195. turana@ccf.org. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   January 2020
Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity after Noncardiac Surgery
Anesthesiology 1 2020, Vol.132, 121-130. doi:https://doi.org/10.1097/ALN.0000000000003000
Anesthesiology 1 2020, Vol.132, 121-130. doi:https://doi.org/10.1097/ALN.0000000000003000
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Low vitamin D is common in the general population

  • In nonsurgical populations, low 25-hydroxyvitamin D is associated with hypertension, left ventricular hypertrophy, heart failure, and coronary artery disease

  • In nonsurgical populations, low vitamin D concentrations are also associated with increased risk of some infections and renal injury

What This Article Tells Us That Is New:

  • Vitamin D deficiency was common in this surgical population

  • Preoperative vitamin D was not associated with a composite of postoperative 30-day cardiac outcomes

  • There was an association between low vitamin D and a composite of infectious complications, and also evidence for an association with decreased kidney function

Background: Low 25-hydroxyvitamin D is associated with cardiovascular, renal, and infectious risks. Postsurgical patients are susceptible to similar complications, but whether vitamin D deficiency contributes to postoperative complications remains unclear. We tested whether low preoperative vitamin D is associated with cardiovascular events within 30 days after noncardiac surgery.

Methods: We evaluated a subset of patients enrolled in the biobank substudy of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) study, who were at least 45 yr with at least an overnight hospitalization. Blood was collected preoperatively, and 25-hydroxyvitamin D was measured in stored samples. The primary outcome was the composite of cardiovascular events (death, myocardial injury, nonfatal cardiac arrest, stroke, congestive heart failure) within 30 postoperative days. Secondary outcomes were kidney injury and infectious complications.

Results: A total of 3,851 participants were eligible for analysis. Preoperative 25-hydroxyvitamin D concentration was 70 ± 30 nmol/l, and 62% of patients were vitamin D deficient. Overall, 26 (0.7%) patients died, 41 (1.1%) had congestive heart failure or nonfatal cardiac arrest, 540 (14%) had myocardial injury, and 15 (0.4%) had strokes. Preoperative vitamin D concentration was not associated with the primary outcome (average relative effect odds ratio [95% CI]: 0.93 [0.85, 1.01] per 10 nmol/l increase in preoperative vitamin D, P = 0.095). However, it was associated with postoperative infection (average relative effect odds ratio [95% CI]: 0.94 [0.90, 0.98] per 10 nmol/l increase in preoperative vitamin D, P adjusted value = 0.005) and kidney function (estimated mean change in postoperative estimated glomerular filtration rate [95% CI]: 0.29 [0.11, 0.48] ml min-1 1.73 m-2 per 10 nmol/l increase in preoperative vitamin D, P adjusted value = 0.004).

Conclusions: Preoperative vitamin D was not associated with a composite of postoperative 30-day cardiac outcomes. However, there was a significant association between vitamin D deficiency and a composite of infectious complications and decreased kidney function. While renal effects were not clinically meaningful, the effect of vitamin D supplementation on infectious complications requires further study.