Vitamin D is one of the most popular vitamin supplements. Vitamin D deficiency affects bones as well as other organs such as the brain, heart, muscles, and the immune system. Low levels of vitamin D have been associated with colon, breast, and prostate cancer. Vitamin D is produced by the skin in response to exposure with ultraviolet B light. Most of us don’t spend much time outside. Is that a problem?
Dr. Alparslan Turan, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, and colleagues hypothesized that noncardiac surgery patients at their facility with low serum vitamin D levels who underwent surgery between 2005 and 2011 would be more likely to experience postoperative morbidity and mortality. The results of this analysis are discussed in the article titled “The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery,” which was published in this month’s issue of Anesthesia & Analgesia.
The authors retrospectively analyzed the data of 3509 patients who had undergone noncardiac surgery at their institution and who also had a serum vitamin D level measurement. Higher vitamin D levels were associated with a lower likelihood of postoperative in-hospital morbidity and mortality and specifically with lower cardiovascular morbidity. During surgery, though patients with lower vitamin D levels were more likely to receive a vasopressor, to receive more red cells and colloid, to receive less crystalloid, and to have faster heart rates intraoperatively, outcomes based on these differences were not significant.
Do lower vitamin D levels cause greater morbidity and mortality, or are people who are more ill less likely to be exposed to the sun? Do people who take better care of themselves also take vitamin D supplements or stay out in the sun more and therefore have a lower incidence of morbidity and mortality?
Drs. Michael F. Roizen, Department of Preventative Medicine, Wellness Institute, Cleveland Clinic Lerner College of Medicine, Lyndhurst, Ohio, and Jeffrey D. Roizen, Department of Pediatrics, Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, write in the accompanying editorial titled “Vitamin D and Your Patients: Don’t Accept Wimpy.” They argue in favor of a definitive, prospective, double-blind, randomized, controlled trial to determine whether vitamin D affects postoperative outcome. Until such a study has been completed, they recommend you, “(1) ask your doctor what your 25-OHD level is, and ask if you need more (we personally aim for 50 to 80 ng/mL, but your doctor may feel differently), [and] (2) get more vitamin D2/3 in supplements if your level is <50.”