The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery

Turan, Alparslan MD*; Hesler, Brian D. MD*; You, Jing MS; Saager, Leif MD*; Grady, Martin MD*; Komatsu, Ryu MD; Kurz, Andrea MD*; Sessler, Daniel I. MD*

Anesthesia & Analgesia:
doi: 10.1213/ANE.0000000000000096
Patient Safety: Research Report

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.

Author Information

From the Departments of *Outcomes Research, Quantitative Health Sciences and Outcomes Research, and Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.

Accepted for publication November 26, 2013.

Funding: Support was provided solely from institutional and/or departmental sources. None of the authors has a personal financial interest in this research.

The authors declare no conflicts of interest.

Address correspondence to Alparslan Turan, MD, Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Ave., P77, Cleveland, Ohio 44195. Address e-mail to

© 2014 International Anesthesia Research Society