Vitamin C Deficiency: A Nutritional Blind Spot in Colorectal Surgery

BackgroundWhile colorectal surgery quality improvement efforts and ERAS pathways emphasize operative sterility, glycemic control, and fluid optimization, perioperative micronutrient status is rarely assessed. Vitamin C is essential for collagen crosslinking, immune function, and antioxidant activity, and deficiency may plausibly impair anastomotic and wound healing. Patients undergoing colorectal surgery may be at particular risk due to baseline malnutrition, disease related malabsorption, postoperative ileus, and reduced enteral intake. The prevalence of vitamin C deficiency in this population remains poorly characterized.MethodsWe conducted a prospective observational study of adults undergoing elective major colon resections between June 2023 and May 2025. Patients taking vitamin C supplements or undergoing anorectal procedures were excluded. Plasma vitamin C levels were obtained postoperatively.ResultsFifty-one patients were included (mean age 56.8 ± 16.7 years). Most procedures were minimally invasive (84.3%). Indications included cancer (52.9%), diverticulitis (25.5%), and Crohn's disease (13.7%). The mean plasma vitamin C concentration was 27.8 ± 16.6 μmol/L. Seven patients (13.7%) had vitamin C deficiency, and an additional 17 (33.3%) had hypovitaminosis C, yielding a total of 47.0% with low levels.ConclusionNearly half of patients undergoing elective colorectal surgery demonstrated low vitamin C levels, with 14% meeting criteria for deficiency. These findings suggest an underrecognized micronutrient vulnerability in this population. Micronutrient assessment and optimization are seldom considered in modern ERAS pathways and may be an opportunity for future quality initiatives.