Association of preoperative vitamin D deficiency with the risk of postoperative delirium and cognitive dysfunction: A meta-analysis

Kuo-Chuan Hung; Li-Kai Wang; Yao-Tsung Lin; Chia-Hung Yu; Chia-Yu Chang; Cheuk-Kwan Sun; Jen-Yin Chen

doi:10.1016/j.jclinane.2022.110681

Association of preoperative vitamin D deficiency with the risk of postoperative delirium and cognitive dysfunction: A meta-analysis

J Clin Anesth. 2022 Aug:79:110681. doi: 10.1016/j.jclinane.2022.110681. Epub 2022 Mar 4.

Authors

Kuo-Chuan Hung¹, Li-Kai Wang¹, Yao-Tsung Lin¹, Chia-Hung Yu², Chia-Yu Chang³, Cheuk-Kwan Sun⁴, Jen-Yin Chen⁵

Affiliations

¹ Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan.
² Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan.
³ Department of Neurology, Chi Mei Medical Center, Tainan City 71004, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan 71004, Taiwan.
⁴ Department of Emergency Medicine, E-Da Hospital, Kaohsiung City 82445, Taiwan; College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan.
⁵ Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan. Electronic address: chenjenyin@gmail.com.

PMID: 35255352
DOI: 10.1016/j.jclinane.2022.110681

Abstract

Study objective: Despite vitamin D deficiency (VDD) associated with cognitive dysfunction in the general population, the impacts of preoperative VDD on postoperative delirium (POD) and cognitive dysfunction (POCD) remain to be clarified.

Design: Meta-analysis of cohort studies.

Setting: Postoperative care.

Intervention: Preoperative VDD as the prognostic factor.

Patients: Adult patients undergoing surgery.

Measurements: Databases including MEDLINE, EMBASE, Google scholar, and the Cochrane Library databases were searched from inception to September 2021. Random-effects modeling was applied to the pooling of results on the association between preoperative VDD and POD/POCD. The primary outcome was the association of VDD with the risk of POD/POCD, while the secondary outcomes included other prognostic factors (e.g., hypertension) with the risk of POD/POCD. A prediction interval (PI) was calculated to indicate the range of a true effect size of a future study in 95% of all populations.

Main results: Meta-analysis of seven observational studies involving 2673 patients showed that the pooled incidence of POD/POCD was 29% (95% confidence interval (CI): 18% to 44%). Our results demonstrated that preoperative VDD increased the risk of POD/POCD [odds ratio (OR) = 1.54, 95% CI: 1.21-1.97, p < 0.01; I² = 29.2%, seven studies, 2673 patients; 95% PI: 0.89-2.67], while vitamin D insufficiency was not associated with a higher risk of POD/POCD (OR = 0.88, 95% CI: 0.49-1.57, p = 0.66; I² = 62.6%, four studies, 1410 patients; 95% PI: 0.09-8.79). The PI in our primary outcome (i.e., 0.89 to 2.67) containing 1.0 suggested the possibility of inconsistent results in future studies. Patients with POD/POCD were older compared to those without. Hypertension, diabetes mellitus, male gender, or smoking was not recognized as risk factors for POD/POCD.

Conclusions: Our results demonstrated that preoperative vitamin D deficiency was associated with postoperative cognitive impairment. Given the prediction interval, more future studies are needed to elucidate associations between VDD and POD/POCD.

Keywords: Postoperative cognitive dysfunction; Postoperative delirium; Risk factors; Surgery; Vitamin D deficiency.

Publication types

Meta-Analysis
Review

MeSH terms

Cognitive Dysfunction* / epidemiology
Cognitive Dysfunction* / etiology
Delirium* / epidemiology
Humans
Hypertension* / complications
Male
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Vitamin D Deficiency* / complications
Vitamin D Deficiency* / epidemiology