Role of vitamin D supplementation in modifying outcomes after surgery: a systematic review of randomised controlled trials

Abstract

BackgroundThere is increasing evidence to suggest vitamin D plays a role in immune and vascular function; hence, it may be of biological and clinical relevance for patients undergoing major surgery. With a greater number of randomised studies being conducted evaluating the impact of vitamin D supplementation on surgical patients, it is an opportune time to conduct further analysis of the impact of vitamin D on surgical outcomes.MethodsMEDLINE, EMBASE and the Cochrane Trials Register were interrogated up to December 2023 to identify randomised controlled trials of vitamin D supplementation in surgery. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool. A narrative synthesis was conducted for all studies. The primary outcome assessed was overall postoperative survival.ResultsWe screened 4883 unique studies, assessed 236 full-text articles and included 14 articles in the qualitative synthesis, comprising 1982 patients. The included studies were highly heterogeneous with respect to patient conditions, ranging from open heart surgery to cancer operations to orthopaedic conditions, and also with respect to the timing and equivalent daily dose of vitamin D supplementation (range: 0.5–7500 mcg; 20–300 000 IU). No studies reported significant differences in overall survival or postoperative mortality with vitamin D supplementation. There was also no clear evidence of benefit with respect to overall or intensive care unit length of stay.DiscussionNumerous studies have reported the benefits of vitamin D supplementation in different surgical settings without any consistency. However, this systematic review found no clear evidence of benefit, which warrants the supposition that a single biological effect of vitamin D supplementation does not exist. The observed improvement in outcomes in low vitamin D groups has not been convincingly proven beyond chance findings.Trial registration numberCRD42021232067.

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

“…In this context, it is worth noting that many complications in the postoperative course may be related to comorbidities that were present before surgery [ 44 ] and could be associated with a low vitamin D status as well. Since osteoporotic hip fracture surgery may not be scheduled weeks ahead and a daily supplementation for at least 3 months prior to surgery is needed to increase 25 (OH) vitamin D serum at the long-term follow-up [ 14 ], treatment strategies should be included in public health interventions. Future regular health checkups provided by the government may take up a screening test for vitamin D deficiencies and subsequent supplementations if needed.…”

“…As vitamin D plays a key role in the overall regulation of the cardiovascular, skeletal, endocrine, and immune systems [ 13 ], hypovitaminosis D may have potential implications for surgery and surgical outcomes as well. A systematic review found no consistency in the benefits of vitamin D supplementation in a number of highly heterogeneous studies [ 14 ]. Nevertheless, to date, no previous study has investigated postsurgical outcomes after osteoporotic hip fractures.…”