title: The association of serum vitamin D concentration with serious complications after noncardiac surgery.
abstract: 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.
authors.affiliation: From the Departments of Outcomes Research, Quantitative Health Sciences and Outcomes Research, and Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.forename: Brian D
authors.initials: BD
authors.lastname: Hesler
authors.forename: Jing
authors.initials: J
authors.lastname: You
authors.forename: Leif
authors.initials: L
authors.lastname: Saager
authors.forename: Martin
authors.initials: M
authors.lastname: Grady
authors.forename: Ryu
authors.initials: R
authors.lastname: Komatsu
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000401:mortality; D015897:Comorbidity; D003428:Cross Infection / Q000401:mortality; D005260:Female; D006339:Heart Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology*; D012189:Retrospective Studies; D018401:Sample Size; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D014655:Vascular Resistance; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications
chemical_list: D014807:Vitamin D