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An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery
Published on: February 17, 2018
Association of Vitamin D Deficiency With Adverse Postoperative Outcomes Following Hallux Valgus Correction
Eve R Glenn1, David Ryu1, Eric Mao1
1Johns Hopkins Department of Orthopaedic Surgery, Baltimore, MD, USA.
Background:
Hallux valgus (HV) is a common forefoot deformity treated surgically. Vitamin D is essential for bone and soft tissue health, but its role in postoperative outcomes after HV is unclear. This study evaluated whether low preoperative vitamin D is associated with increased complications.
Methods:
Adults undergoing HV correction were analyzed retrospectively using the TriNetX Research Network. Patients were categorized as vitamin D deficient (≤20 ng/mL), subsufficient (≤30 ng/mL), or sufficient (≥30 ng/mL). Secondary analyses examined outcomes by surgical setting (inpatient vs ambulatory) and procedure type among subsufficient patients. Propensity score matching controlled for demographics and comorbidities. Ninety-day outcomes included wound complications, health care visits, opioid use, and thromboembolic events. Significance was set at P <.05.
Results:
After matching, 7041 deficient and 8150 subsufficient patients were compared with equal numbers of sufficient controls. Vitamin D deficiency and subsufficiency were associated with higher rates of wound dehiscence, postoperative infection, inpatient consultation/admission, emergency department (ED) visits, and opioid use (all P < .05). In secondary analyses, 1286 inpatient and 6346 ambulatory subsufficient and sufficient patients were matched. Vitamin D subsufficiency was associated with higher ED visits in inpatients and increased wound dehiscence, inpatient encounters, ED visits, and opioid use in ambulatory patients (all P < .05). Among 3600 vitamin D-subsufficient patients per cohort, metatarsophalangeal (MTP) fusion had higher wound dehiscence than HV correction (P = .033).
Conclusion:
Low preoperative vitamin D is associated with increased postoperative complications after HV, including wound dehiscence, infection, health care utilization, and opioid use. Subsufficient vitamin D was linked to higher ED visits in inpatients and increased wound dehiscence, inpatient encounters, ED visits, and opioid use in ambulatory patients. Among subsufficient patients, MTP fusion had higher wound dehiscence than HV correction, likely due to greater soft tissue disruption. These findings highlight that both vitamin D status and procedure type are associated with postoperative complications; however, given the modest absolute risk differences, preoperative vitamin D screening should be viewed as a possible risk-stratification tool.
Level Of Evidence:
Level III, cohort study.
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