The importance of vitamins for overall health has long been recognized [1]. Recent studies have found that optimization of vitamin levels prior to surgery is associated with improved surgical outcomes, leading to an increased awareness of the relationship between nutrition and recovery from surgery [1].
The influence of vitamin D levels on post-surgical outcomes has recently become a research topic of interest [2]. Vitamin D is a fat-soluble steroid hormone that is important for musculoskeletal health, playing a role in over 300 metabolic pathways [2]. Epidemiological studies have demonstrated that vitamin D is both cardioprotective and neuroprotective [3]. Additionally, it plays a role in innate and acquired immunity [3]. The recommended circulating vitamin D level is >75 nmol/L [4]. Vitamin D deficiency is most commonly caused by inadequate sun exposure and can lead to rickets in children and exacerbated osteopenia, osteoporosis, and fractures in adults [4]. Deficiencies are also associated with an increased risk of cancer, autoimmune diseases, hypertension, and infectious disease [4]. In cases of low vitamin D serum concentrations, vitamin D supplements are effective for maintaining healthy blood concentrations [4]. Higher vitamin D levels are associated with decreased risk of in-hospital mortality and morbidity [3].
A 2013 study completed by researchers at the University of Ottawa found that vitamin D deficiency contributes to secondary organ pathophysiology, prolonged stays in the ICU, and worse outcomes in critically ill patients [5]. The researchers focused on children with congenital heart disease (CHD), a high-risk pediatric population [5]. Post-operatively, patients with CHD commonly experience pronounced systemic inflammation, coagulopathy, respiratory failure, electrolyte disturbances, arrhythmia, myocardial dysfunction, kidney failure, and infection [5]. Vitamin D supplementation prior to surgery was determined to be an ideal intervention for improving post-surgical outcomes in children with CHD [5].
Similarly, a 2019 study led by researchers at the University of Edinburgh and Trinity College Dublin found strong evidence of an association between lower vitamin D levels and adverse colorectal cancer survival following surgical resection [6]. The results of the study also pointed to a strong genotype-specific effect of vitamin D, with a post-surgical survival association greatest in those with a single nucleotide polymorphism within the VDR gene sequence (rs11568820) [6].
The impact of other vitamins on surgical outcomes continues to be explored [7]. It is known that vitamin C is a key requirement for proper wound healing [7]. Sufficient levels of vitamin C are necessary for protocollogen hydroxylase enzyme activity, which produces collagen, the most abundant protein in the body [7]. Vitamin A has also been found to have significant wound-healing activity [7]. Vitamin A is important for proper functioning of the inflammatory response and synthesis of collagen and ground substances [7]. Lastly, vitamin K has been linked to decreased post-operative bleeding [8]. In patients receiving a left ventricular assist device (LVAD), bleeding more than 48 hours post-implant occurred in only 5% of pre-operative vitamin-K treated patients as opposed to 26% of patients not treated with vitamin K [8].
Optimization of nutritional state, including vitamin levels, prior to surgery leads to improved surgical outcomes [1]. As the body of literature showing the connection between vitamin levels and surgical outcomes grows, nutritional screening protocols should be considered in the pre-operative evaluation of patients [1].
References
- Evans, D., Martindale, R., Kiraly, L., & Jones, C. (2013). Nutrition Optimization Prior to Surgery. Nutrition in Clinical Practice, 29(1), 10-21. doi:10.1177/0884533613517006
- Iglar, P., & Hogan, K. (2015). Vitamin D status and surgical outcomes: a systematic review. Patient Safety in Surgery, 9(1). doi:10.1186/s13037-015-0060-y
- Turan, A., Hesler, B., You, J., Saager, L., Grady, M., & Komatsu, R. et al. (2014). The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery. Anesthesia & Analgesia, 119(3), 603-612. doi:10.1213/ane.0000000000000096
- Holick, M., & Chen, T. (2008). Vitamin D deficiency: a worldwide problem with health consequences. The American Journal of Clinical Nutrition, 87(4), 1080S-1086S. doi:10.1093/ajcn/87.4.1080s
- McNally, J., & Menon, K. (2013). Vitamin D deficiency in surgical congenital heart disease: Prevalence and relevance. Translational Pediatrics, 2(3), 99-111. doi:10.3978/j.issn.2224-4336.2013.07.03
- Vaughan-Shaw, P.G., Zgaga, L., Ooi, L. Y., et al. (2019). Low plasma vitamin D is associated with adverse colorectal cancer survival after surgical resection, independent of systemic inflammatory response. BMJ, 69(1), 103-111. doi:10.1136/gutjnl-2018-317922
- Rahm, D. (2004). A guide to perioperative nutrition. Aesthetic Surgery Journal, 24(4), 385-390. doi:10.1016/j.asj.2004.04.001
- Kaplon, R., Gillinov, A., Smedira, N., Kottke-Marchant, K., Wang, I., Goormastic, M., & McCarthy, P. (1999). Vitamin K reduces bleeding in left ventricular assist device recipients. The Journal of Heart and Lung Transplantation, 18(4), 346-350. doi:10.1016/s1053-2498(98)00066-7
