Preoperative Vitamin D Deficiency is Associated with Increased One-Year Mortality in Chinese Geriatric Hip Fracture Patients – A Propensity Score Matching Study

Abstract

Background Vitamin D deficiency is a common comorbidity in geriatric hip fracture patients. However, there is still an ongoing debate regarding the influence of preoperative Vitamin D status on postoperative mortality in hip fracture patients. Methods Elderly patients (≥60 years) who underwent surgical interventions for unilateral hip fracture from 2015 to 2020 in our center were included. We retrospectively retrieved the demographic data from the electronic medical database. Preoperative serum total 25-hydroxy-Vitamin D was set as the independent variable and patients were classified as the Vitamin D deficiency (<20ng/mL) and the control groups consequently. Clinical outcomes include all-cause mortality, walking ability, and major postoperative complications in the first postoperative year. Propensity score matching (PSM) was performed in a ratio of 1:1 in the two groups for further comparison. Results A total of 210 patients were included and 121 patients (57.6%) were diagnosed with Vitamin D deficiency. Patients in the Vitamin D deficiency group were much older and therefore preferred peripheral nerve block, and had significantly higher proportions of females, preoperative dementia, higher ASA grade, and lower baseline serum albumin level. Overall, 79 patients were identified in the Vitamin D deficiency and control groups after PSM, respectively. Patients diagnosed with Vitamin D deficiency showed a significantly higher one-year mortality (21.5% vs 6.3%, P=0.011) and a much lower one-year independent walking rate (67.1% vs.84.8%, P=0.016) after the matching. Regarding the dataset before PSM and after PSM, the AUC for serum Vitamin D for predicting one-year mortality was 0.656 (P=0.006) and 0.695 (P=0.002), respectively. Conclusion Our retrospective PSM-design study provides new evidence that Vitamin D deficiency was associated with a significantly higher mortality and poor walking ability in the first year after surgical intervention based on southern Chinese populations.

Impact of vitamin D deficiency on mortality in patients with hip fracture: A meta‐analysis

“…No relevant unpublished studies have been published to date. Ultimately, a total of nine studies were included in the meta‐analysis 7,15–22 …”

Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review

“…More specifically, preoperative serum 25(OH)D > 12 ng/mL were associated with 30- and 60-day increased mobility [ 77 ]. Subsequent retrospective analyses confirmed the association between pre-surgical vitamin D deficiency and 6- or 12-month worse physical outcomes, re-admission for medical issues, and re-fracture in elderly subjects [ 78 , 79 , 80 ]. More recently, a meta-analysis of these and other studies in a total of 1972 hip fractured patients aged 78–84 demonstrated that vitamin D deficiency was associated with poorer quality of life and functional ability after fracture, while it did not influence the walking ability and length of stay in the hospital [ 74 ].…”

Increased Early Postoperative Complication Rate after Osteoporotic Hip Fracture in Patients with Low 25 (OH) Vitamin D Levels

“…While various factors may contribute to patients’ survival after surgical procedures, it is worth mentioning that 12 of 13 patients in the present study had a vitamin D level below the normal range (<30 ng/mL). A large body of evidence has demonstrated that higher postoperative mortality rates among hip fracture patients are linked to lower levels of vitamin D at 30 days [ 33 ], 1 year [ 34 , 35 , 36 , 37 ], and 2 years [ 36 ] of follow-up. The pooled data of a recent meta-analysis on femur fracture patients revealed that vitamin D insufficiency and severe deficiency are associated with increased mortality in patients with hip fractures.…”