Delirium 2.2 X more likely after surgery if Vitamin D deficient - July 2025
Preoperative vitamin D deficiency and postoperative delirium risk: multicenter retrospective study
Front Nutr. 2025 Jul 17:12:1617670. doi: 10.3389/fnut.2025.1617670 PDF behind a paywall
Kuo-Chuan Hung 1 2, Ting-Sian Yu 3, Shu-Wei Liao 1 4, Yi-Chen Lai 1 2, Pei-Han Fu 1, Ping-Hsun Feng 5, I-Wen Chen 2 5
Background: To assess the impact of preoperative vitamin D deficiency (VDD) on the risk of postoperative delirium (POD) in patients undergoing musculoskeletal surgery.
Methods: This cohort study utilized the TriNetX Healthcare Commercial Organizations database. We included patients aged 50 years or older who underwent musculoskeletal surgery requiring hospital admission. Patients were categorized according to their preoperative vitamin D levels into three groups: deficient (≤20 ng/mL), insufficient (21-29 ng/mL), and sufficient (≥30 ng/mL). The primary outcome was POD within 30 days of surgery. Secondary outcomes included risks of surgical site infections, emergency department (ED) visits, and intensive care unit (ICU) admissions. Risk factors for POD were assessed using multivariate logistic regression analysis.
Results: After matching, 6,218 pairs of vitamin D-deficient and sufficient patients were compared.
- VDD was related to a significantly higher risk of POD [1.0% vs. 0.5%; odds ratio (OR): 2.18, 95% confidence interval (CI): 1.41-3.36, p < 0.001].
- Vitamin D-deficient patients also had higher rates of ED visits (OR: 1.36, 95% CI: 1.18-1.57, p < 0.001)
- and ICU admissions (OR: 1.51, 95% CI: 1.19-1.91, p < 0.001).
- Similarly, vitamin D insufficiency (10,764 matched pairs) was associated a
- smaller but significant increase in delirium risk (OR: 1.49, 95%CI: 1.05-2.12, p = 0.023),
- along with increased ED visits (OR: 1.16, 95% CI: 1.03-1.30, p = 0.013) and
- ICU admissions (OR: 1.25, 95% CI: 1.03-1.52, p = 0.0261),
suggesting a dose-dependent relationship.
Risk factor analysis revealed that advanced age, male sex, chronic kidney disease, and malnutrition were significant predictors of POD in patients with VDD.
Conclusion: Individuals with VDD experienced a higher risk of POD, suggesting the potential benefits of preoperative vitamin D screening and supplementation as a strategy to improve outcomes in surgical patients. While our findings highlight the potential benefit of vitamin D assessment and optimization before surgery, the retrospective design limits the ability to draw causal inferences. Prospective interventional studies are warranted to determine whether treating VDD can meaningfully lower the risk of POD.
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Hospital delirium 2X more-likely if <10 ng of vitamin D - meta-analysis Feb 2023
Association between vitamin D concentration and delirium in hospitalized patients: A meta-analysis
PLoS One . 2023 Feb 8;18(2):e0281313. doi: 10.1371/journal.pone.0281313
Ningning Fu 1, Mengrong Miao 1, Ningning Li 1, Shuang Zeng 1, Ruilou Zhu 1, Jiaqiang Zhang 1
Background: Now the occurrence of delirium is more concerning to clinicians and psychiatrists. It has been reported that vitamin D deficiency may be a relevant factor in the development of delirium in hospitalized patients.
Study objective: To investigate the association between vitamin D concentration and delirium in hospitalized patients.
Design: Meta-analysis.
Methods: A systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library. The primary outcome was the occurrence of delirium in the inpatient setting. Odds ratios (OR) were calculated with random or fixed effects models.
Results: In this article, we define the normal range of vitamin D concentrations as greater than 75 nmol / L, 50-75 nmol / L as vitamin D insufficiency, 25-50 nmol / L as vitamin D deficiency, and less than 25 nmol / L as vitamin D severe deficiency. The Results showed that
- severe vitamin D deficiency (OR: 1.98 [1.41-2.79], P<0.001) and
- vitamin D deficiency (OR: 1.50 [1.12-2.00], P = 0.006)
were more likely to develop delirium than normal vitamin D levels.
Subgroup analysis also revealed that low vitamin D concentrations were associated with a higher incidence of delirium, whether the cutoff point was 25 nmol/L (OR: 1.52 [1.40-1.64], P<0.001), 50 nmol/L (OR: 1.47 [1.19-1.82], P<0.001), or 75 nmol/L (OR: 1.54 [1.21-1.96], P<0.001). The included studies scored medium and high on the Newcastle-Ottawa quality assessment scale.
Conclusion: Compared with normal vitamin D levels, severe vitamin D deficiency and vitamin D deficiency, but not vitamin D insufficiency, are associated with a higher incidence of delirium in hospitalized patients.
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