title: The relationship between immediate preoperative serum 25-hydroxy-vitamin D₃ levels and cardiac function, dysglycemia, length of stay, and 30-d readmissions in cardiac surgery patients.
abstract: OBJECTIVE
  Vitamin D has pleiotropic effects on cardiac, renal, and endocrine diseases like diabetes mellitus and deficiency has been correlated with increased Intensive Care Unit (ICU) morbidity and mortality. We studied the relationship between preoperative Vitamin D levels and several short-term endpoints including cardiovascular events, glucose levels, ICU, and hospital length of stay.
  
  
  METHODS
  Standard demographic data were obtained. Blood samples were drawn for 25-hydroxy-vitamin D3 (Vit D) levels at baseline (just before induction of anesthesia) and on postoperative day (POD #1). The number of inotropes used on POD # 0, 1, and 2 was recorded as well as the Cardiac Index (CI). Baseline glucose, Blood Urea Nitrogen and Creatinine (Cr) levels were obtained and repeated on POD # 1 & 2. Other variables studied are number of days of ICU and hospital stay.
  
  
  RESULTS
  Of the 64 patients included in the cohort, 3 were excluded because of inadequate data. 69% had Vit D levels <20 ng/mL and 31% had levels ≥20 ng/mL. More than 90% of the cohort had a significant decrease in POD # 1 Vit D levels (P < 0.001). Age, sex, race, and body mass index did not predict the preoperative Vit D levels; however, the timing of surgery was associated with preoperative Vit D levels, lowest in subjects who had surgery performed during winter. Preoperative Vit D levels had no effect on postoperative glycemic control, cardiac index, or composite outcome-arrhythmias, respiratory failure, or prolonged inotropic support. On regression analysis, preoperative Vit D levels did show a significant effect on ICU and hospital length of stay in this cohort.
  
  
  CONCLUSIONS
  The low levels in this study truly represent the Vit D status as they were obtained before any intervention, including surgery or fluid administration. Vit D levels decreased rapidly after surgery and hence future studies on Vit D may need to focus on premorbid levels obtained at the time of initial presentation and not those obtained after resuscitation or ICU admission. In contrast to epidemiologic reports, we found no association between low Vit D levels and postoperative cardiovascular events. However, low Vit D levels did affect the ICU and hospital length of stay in patients who were undergoing cardiac surgery. This is an important finding especially when many institutions and regulatory agencies are investigating novel therapies and processes to reduce the length of hospitalization. More studies are required to investigate the effect on hospital length of stay of early preadmission or preoperative Vit D supplementation before elective surgery.
authors.affiliation: Division of Surgical Critical Care, Department of Surgery, Stroger Hospital of Cook County, Chicago, Illinois, USA. Electronic address: ksriram41@hotmail.com.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Sriram
authors.affiliation: Division of Nephrology, Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA.
authors.forename: Kalyani
authors.initials: K
authors.lastname: Perumal
authors.affiliation: Department of Anesthesiology and Pain Management, Stroger Hospital of Cook County, Chicago, Illinois, USA.
authors.forename: Golnaz
authors.initials: G
authors.lastname: Alemzadeh
authors.affiliation: Division of Nephrology, Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Osei
authors.affiliation: Department of Anesthesiology and Pain Management, Stroger Hospital of Cook County, Chicago, Illinois, USA.
authors.forename: Gennadiy
authors.initials: G
authors.lastname: Voronov
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001806:Blood Urea Nitrogen; D006348:Cardiac Surgical Procedures; D002762:Cholecalciferol / Q000097:blood*; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006321:Heart / Q000502:physiology* / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications; D012621:Seasons
chemical_list: D001786:Blood Glucose; D002762:Cholecalciferol
keywords: 25-Hydroxy vitamin D; Cardiac function; Dysglycemia; Hospital length of stay; ICU length of stay; Vitamin D