Vitamin D Deficiency and Risk of Surgical Site Infections: A Systematic Review and Meta-Analysis

Surgical site infection (SSI) places a burden on the healthcare system and patients. Literature suggests that vitamin D has indirect antimicrobial effects and an association with a reduction in infections. We aim to evaluate the association between vitamin D deficiency in developing SSIs in adult surgical patients.

Embase, Medline, Clinicaltrials.gov, WHO-ICTRP, Cochrane, Web of Science, CINAHL, Google Scholar, Cochrane Central Register of Controlled Trials, and Citations were searched. Observational studies that evaluated key question were included. The meta-analysis was carried out using bias-adjusted inverse variance heterogeneity methods. A risk of bias assessment was done using the MASTER Scale. The Doi plot and the Luis Furuya-Kanamori index were utilized to visualize and quantify the asymmetry of study effects, respectively, to evaluate publication bias. The GRADE method was utilized for assessing the certainty of evidence.

This meta-analysis included 12,737 patients from eight eligible cohort studies. The overall analysis based on vitamin D cut-off levels revealed that vitamin D deficiency (<20 ng/mL) is associated with increased odds of SSI (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 0.80-2.05; I² = 37.2%, p = 0.18). Notably, a cut-off level of <30 ng/mL is linked to even higher odds of SSI (OR: 3.84, 95% CI: 2.13-5.56; I² = 0.0%, p = 0.83).

This meta-analysis found a significant association between vitamin D deficiency and an increased risk of SSI. Taken together, these studies suggest that vitamin D deficiency may play a role in SSI development. However, in order to determine if vitamin D supplementation alone will reduce the risk of a post-operative SSI, a prospective clinical trial is necessary.