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

Abstract

2.6%; P = 0.23]). The values decreased after the BCP in the control group, but in the AVP group, 10% decreases were noted with AVP alone and further decreased after the BCP (P < 0.0001). Hypotension occurred less often in the AVP patients than in the control group; 2 patients (13%) in the AVP group and 10 (67%) in the control group required ephedrine (P = 0.003). In the control group, the episodes occurred within 5 minutes of the BCP and lasted 2 to 15 minutes compared with 10 to 15 minutes and 1.5 to 2.5 minutes, respectively, in the AVP group. Among the 30 patients, SjvO 2 values decreased below 50% in 20 and below 40% in 11 patients. However, neither the incidence of SjvO 2 of less than 50% nor less than 40% differed between groups. The incidence of cerebral oxygen desaturation was 80% in the AVP group compared with 13% in the control patients (P = 0.0003).Arginine vasopressin was effective when given as a prophylactic bolus to prevent hypotension caused by the BCP in patients undergoing shoulder surgery. However, it was associated with a negative effect on regional cerebral oxygenation with upright positioning, which must be considered in clinical practice. Therefore, AVP should be used cautiously until future studies can determine more thoroughly and definitively its effects on cerebral oxygenation and hemodynamics. COMMENTArthroscopic shoulder surgery is often performed in the BCP because it offers several advantages including optimal anatomical orientation and surgical access, easy conversion to open surgery without repositioning, less risk of nerve traction injury, and possibly improved surgical outcome compared with the lateral decubitus position. The BCP, however, is frequently associated with systemic hypotension owing to pooling of blood in the lower extremities, which can result in cerebral hypoperfusion as evidenced by a low regional cerebral oxygen saturation. Regional anesthesia appears to protect cerebral perfusion by maintaining cerebral autoregulation better than general anaesthesia. Interestingly, the incidence of overt neurologic injury is low despite evidence of cerebral hypoperfusion.Short-acting vasopressors such as phenylephrine and ephedrine are routinely used in clinical practice to treat hypotension in the perioperative period. Arginine vasopressin is a long-acting potent vasopressor with a superior cerebral hemodynamic profile compared with phenylephrine and is useful in shock secondary to sepsis and cardiac surgery.In the current study, the authors evaluated the effect of AVP on hemodynamics and cerebral oxygenation during postural changes in the BCP. Thirty patients were randomized to receive AVP 0.07 U/kg or saline 20 minutes after induction of general anesthesia (GA) and before being placed in the BCP. Cerebral oxygenation was measured using continuous jugular venous saturation (SjvO 2 ) and regional tissue oxygen saturation (SctO 2 ) using near-infrared spectroscopy with the INVOS 5100B cerebral oximeter (Somanetics, Troy, Mich). Mean arterial pressure was reduced with induction ...

Season and vitamin D status do not affect probability for surgical site infection after colorectal surgery

“…LaPar et al [11] reported that, the morbidity and mortality of patients were lowest in patients operated in spring after lung resection and Kestle et al [12] reported that complications such as infection and wound dehiscence were higher in July and August after pediatric shunt surgery. Gruskay et al [13] very similar to our results found that surgical infections decreased to the lowest point in the spring (2.8 %) when compared with summer (4.1 %), less postoperative infection rate (4.6 %) [15]. However, we found no association with vitamin D levels and SSI.…”

Is Vitamin D Important for Elderly Patients in Intensive Care?

“…High vitamin D levels were found to significantly decrease mortality rates. Also, vitamin D concentration was associated with mortality at the hospital, serious infection, and serious cardiovascular events (37). In contrast to these studies, there was no significant relationship between vitamin D levels and APACHE II scores, which indicate mortality, in both groups in our study.…”

Serum Total 25‐OH Vitamin D Adds Little Prognostic Value in Patients Undergoing Coronary Catheterization

“…Even if 25‐OH vitamin D is simply a risk marker correlated with causal risk factors, there remains strong interest in whether it can better identify high‐ and low‐risk patients compared to established risk factors. In several prospective cohort studies of postsurgical or intensive care unit patients, 25‐OH vitamin D was inversely associated with late discharge, in‐hospital death, serious infections, disease severity, and secondary CVD events . Furthermore, in a study of 3371 patients undergoing coronary artery bypass grafting or valve surgery, 25‐OH vitamin D was inversely associated with postoperative cardiac complications including in‐hospital death, myocardial infarction, low output syndrome, and stroke .…”

“…While several clinical studies have evaluated the association between 25‐OH vitamin D and risk of CVD outcomes, complications, and mortality following surgery or hospitalization, few have fully evaluated the prognostic value of 25‐OH vitamin D by contrasting model discrimination, fit, and calibration to those from models containing established risk factors. Furthermore, none have examined the ability of 25‐OH vitamin D to appropriately reclassify patient risk when added to models containing established risk factors.…”