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Original Investigation |

Association Between Preoperative 25-Hydroxyvitamin D Level and Hospital-Acquired Infections Following Roux-en-Y Gastric Bypass Surgery

Sadeq A. Quraishi, MD, MHA1; Edward A. Bittner, MD, PhD1; Livnat Blum, BA1; Mathew M. Hutter, MD, MPH1; Carlos A. Camargo Jr, MD, DrPH1
[+] Author Affiliations
1Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2014;149(2):112-118. doi:10.1001/jamasurg.2013.3176.
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Importance  Postoperative hospital-acquired infections (HAIs) may result from disruption of natural barrier sites. Recent studies have linked vitamin D status and barrier site integrity.

Objective  To investigate the association between preoperative vitamin D status and the risk for HAIs.

Design, Setting, and Participants  A retrospective analysis was performed using propensity score methods to construct a matched-pairs cohort to reduce baseline differences between patients with 25-hydroxyvitamin D (25[OH]D) levels less than 30 ng/mL vs 30 ng/mL or greater. Multivariable logistic regression analysis was then performed to examine the association between 25(OH)D levels and HAIs while adjusting for additional perioperative factors. Locally weighted scatterplot smoothing was used to depict the relationship between increasing 25(OH)D levels and the risk for HAIs. This study was conducted in a single, teaching hospital in Boston, Massachusetts, and involved 770 gastric bypass surgery patients between January 1, 2007, and December 31, 2011.

Exposures  Preoperative 25(OH)D levels.

Main Outcomes and Measures  Association between preoperative 25(OH)D levels and the risk for postoperative HAIs.

Results  The risk for HAIs was 3-fold greater (adjusted odds ratio, 3.05; 95% CI, 1.34-6.94) in patients with 25(OH)D levels less than 30 ng/mL vs 30 ng/mL or greater. Further adjustment for additional perioperative factors did not materially change this association. Locally weighted scatterplot smoothing analysis depicted a near inverse linear relationship between vitamin D status and the risk for HAIs for 25(OH)D levels around 30 ng/mL.

Conclusions and Relevance  In our patient cohort, a significant inverse association was observed between preoperative 25(OH)D levels and the risk for HAIs. These results suggest that preoperative 25(OH)D levels may be a modifiable risk factor for postoperative nosocomial infections. Prospective studies must determine whether there is a potential benefit to preoperative optimization of vitamin D status.

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Figure 1.
Vitamin D Status vs Risk for Hospital-Acquired Infections

Between 25-hydroxyvitamin D levels of 0 and 30 ng/mL, there is an almost linear reduction in the risk for infection.

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Figure 2.
Vitamin D Status vs Risk for Surgical Site Infections

Between 25-hydroxyvitamin D levels of 0 and 30 ng/mL, there is an almost linear reduction in the risk for infection.

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