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Association between preoperative 25-hydroxyvitamin D3 levels and postoperative delirium in pediatric patients
Li Li1,2, Haoqi Wang1,2, Jinzhu Liu2
1Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China.
Insights
Pediatric patients with preoperative vitamin D deficiency (VDD) face a significantly higher risk of postoperative delirium (POD) after general anesthesia. Early VDD screening may identify children needing intervention to prevent POD.
Area of Science:
- Pediatric Anesthesiology
- Nutritional Neuroscience
- Critical Care Medicine
Background:
- Postoperative delirium (POD) is a frequent complication in children following general anesthesia, impacting recovery.
- While vitamin D deficiency (VDD) is implicated in adult POD, its role in pediatric populations is not well-established.
- Understanding VDD's impact on pediatric POD is crucial for improving perioperative care.
Purpose of the Study:
- To investigate the association between preoperative 25-hydroxyvitamin D3 [25(OH)D3] levels and the incidence of POD in pediatric patients.
- To identify preoperative VDD as a potential risk factor for POD in children undergoing laparoscopic surgery.
- To explore the correlation between vitamin D status and postoperative outcomes in pediatric anesthesia.
Main Methods:
- A single-center retrospective study included 320 pediatric patients undergoing laparoscopic surgery under general anesthesia.
- Preoperative serum 25(OH)D3 levels were measured, and POD was assessed using the Cornell Assessment of Pediatric Delirium (CAPD) scale.
- Multivariable logistic regression analysis was employed to determine independent risk factors for POD, categorizing patients into VDD (<30 ng/mL) and non-VDD (≥30 ng/mL) groups.
Main Results:
- The incidence of POD was high at 80.3%, with POD patients exhibiting significantly lower preoperative 25(OH)D3 levels.
- Preoperative VDD was independently associated with a substantially increased risk of POD (adjusted OR = 14.25, P<0.001).
- Sensitivity analysis incorporating postoperative sleep quality confirmed the robustness of the VDD-POD association (OR = 8.15, P=0.005).
Conclusions:
- Preoperative vitamin D deficiency is a significant independent risk factor for postoperative delirium in pediatric patients undergoing general anesthesia.
- Preoperative screening for VDD may aid in identifying children at higher risk for POD.
- Further research, including randomized controlled trials, is warranted to assess the efficacy of vitamin D supplementation in reducing pediatric POD.
Background:
Postoperative delirium (POD) is a common complication after pediatric general anesthesia, impairing recovery. While vitamin D deficiency (VDD) is linked to POD in adults, its role in children remains unclear. This study investigates the association between preoperative 25-hydroxyvitamin D3 [25(OH)D3] levels and POD in children undergoing laparoscopic surgery under general anesthesia.
Methods:
This single-center retrospective study enrolled 320 pediatric patients. Demographic, surgical, anesthetic, and laboratory data were collected. Preoperative serum 25(OH)D3 was measured, and POD was assessed using the Cornell Assessment of Pediatric Delirium (CAPD) scale on postoperative days 1, 3, and 7. Meanwhile, patients were categorized into VDD (<30 ng/mL) and non-VDD (≥30 ng/mL) groups. Multivariable logistic regression identified independent risk factors for POD.
Results:
The incidence of POD was 80.3% (257/320) based on the CAPD score ≥9. POD patients had significantly lower serum 25(OH)D3 levels (P<0.05). In multivariable analysis, preoperative VDD was independently associated with a significantly higher risk of POD [adjusted odds ratio (OR) =14.25; 95% confidence interval (CI): 3.33-61.0; P<0.001]. A sensitivity analysis incorporating postoperative sleep quality [Children's Sleep Habits Questionnaire (CSHQ) score] confirmed the robustness of this association (OR =8.15; 95% CI: 1.88-35.3; P=0.005). The area under the receiver operating characteristic (ROC) curve for 25(OH)D3 in identifying POD was 0.613.
Conclusions:
Preoperative VDD is independently associated with a substantially increased risk of POD in pediatric patients undergoing general anesthesia for laparoscopic surgery. Preoperative screening for VDD may help identify at-risk children, and randomized controlled trials are warranted to evaluate whether preoperative vitamin D supplementation reduces POD incidence.