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Patel A, Caruana EJ, Hodson J, Morrison R, Khor B, Gysling S, Trevis J, Mangel T, Benson R, Zakeri R, Manders J, Vaja R, Rogers L, Baker P, Pournaras DJ, Thickett D, Hewison M, Naidu B, Lim E. Role of vitamin D supplementation in modifying outcomes after surgery: a systematic review of randomised controlled trials. BMJ Open 2024; 14:e073431. [PMID: 38233048 PMCID: PMC10806719 DOI: 10.1136/bmjopen-2023-073431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND There is increasing evidence to suggest vitamin D plays a role in immune and vascular function; hence, it may be of biological and clinical relevance for patients undergoing major surgery. With a greater number of randomised studies being conducted evaluating the impact of vitamin D supplementation on surgical patients, it is an opportune time to conduct further analysis of the impact of vitamin D on surgical outcomes. METHODS MEDLINE, EMBASE and the Cochrane Trials Register were interrogated up to December 2023 to identify randomised controlled trials of vitamin D supplementation in surgery. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool. A narrative synthesis was conducted for all studies. The primary outcome assessed was overall postoperative survival. RESULTS We screened 4883 unique studies, assessed 236 full-text articles and included 14 articles in the qualitative synthesis, comprising 1982 patients. The included studies were highly heterogeneous with respect to patient conditions, ranging from open heart surgery to cancer operations to orthopaedic conditions, and also with respect to the timing and equivalent daily dose of vitamin D supplementation (range: 0.5-7500 mcg; 20-300 000 IU). No studies reported significant differences in overall survival or postoperative mortality with vitamin D supplementation. There was also no clear evidence of benefit with respect to overall or intensive care unit length of stay. DISCUSSION Numerous studies have reported the benefits of vitamin D supplementation in different surgical settings without any consistency. However, this systematic review found no clear evidence of benefit, which warrants the supposition that a single biological effect of vitamin D supplementation does not exist. The observed improvement in outcomes in low vitamin D groups has not been convincingly proven beyond chance findings. TRIAL REGISTRATION NUMBER CRD42021232067.
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Affiliation(s)
- Akshay Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Edward J Caruana
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - James Hodson
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rory Morrison
- Department of Orthopaedic Surgery, South Tees NHS Foundation Trust, Nottingham, UK
| | - Bo Khor
- Department of Colorectal Surgery, University Hospitals Birmingham, Nottingham, UK
| | - Savannah Gysling
- Department of Academic Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jason Trevis
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesborough, UK
| | - Tobin Mangel
- Department of Cardiothoracic Surgery, Bart's Heart Centre, London, UK
| | - Ruth Benson
- Department of Vascular Surgery, University of Otago, Christchurch, New Zealand
| | - Roxanna Zakeri
- Department of Upper GI, Bariatric and Metabolic Surgery, North Bristol NHS Trust, Westbury on Trym, UK
| | - Jennifer Manders
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ricky Vaja
- Department of Cardiovascular Sciences Surgery, Imperial College London, London, UK
| | - Luke Rogers
- Department of Cardiac Surgery, University Hospitals Bristol, Bristol, UK
| | - Paul Baker
- Department of Orthopaedic Surgery, South Tees NHS Foundation Trust, Nottingham, UK
- University of Teeside, Middlesborough, UK
| | - Dimitri J Pournaras
- Department of Upper GI, Bariatric and Metabolic Surgery, North Bristol NHS Trust, Westbury on Trym, UK
| | - David Thickett
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Babu Naidu
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Eric Lim
- Department of Thoracic Surgery, Royal Brompton Hospital, London, UK
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Jin X, Shen J, Liu T, Zhou R, Huang X, Wang T, Wu W, Wang M, Xie R, Yuan J. The significance of short-term preoperative calcium and activated vitamin D3 supplementation in thyroidectomy: a randomized trial and prospective study. Endocr Connect 2024; 13:e230377. [PMID: 37947264 PMCID: PMC10762556 DOI: 10.1530/ec-23-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/09/2023] [Indexed: 11/12/2023]
Abstract
Objective The aim was to explore the effects of preoperative calcium and activated vitamin D3 supplementation on post-thyroidectomy hypocalcemia and hypo-parathyroid hormone-emia (hypo-PTHemia). Methods A total of 209 patients were randomly divided into control group (CG) and experimental group (EG). Oral calcium and activated vitamin D3 supplementation were preoperatively administered to EG, whereas a placebo was administered to CG. Data on serum calcium, phosphorus, and PTH concentrations before operation, on postoperative day 1 (POPD1), at postoperative week 3 (POPW3), and on the length of postoperative hospitalization were collected. Results The serum calcium, phosphorus, and PTH concentrations, as well as the incidence of postoperative hypocalcemia and hypo-PTHemia, did not significantly differ between EG and CG. Subgroup analysis revealed that the serum calcium concentrations of the experimental bilateral thyroidectomy subgroup (eBTS) on POPD1 and POPW3 were higher than that of the control bilateral thyroidectomy subgroup (cBTS) (P < 0.05); the reduction of serum calcium in eBTS on POPD1 and POPW3 was less than those in cBTS (P < 0.05). However, significant differences were not observed between the unilateral thyroidectomy subgroups (UTS) (P > 0.05). Moreover, the incidence of postoperative hypocalcemia in cBTS on POPD1 was significantly higher than that in eBTS (65.9% vs 41.7%) (P < 0.05). The length of hospitalization in cBTS (3.55 ± 1.89 days) was significantly longer than that (2.79 ± 1.15 days) in eBTS (P < 0.05). Conclusion Short-term preoperative prophylactic oral calcium and activated vitamin D3 supplementation could effectively reduce the incidence of postoperative hypocalcemia and decrease the length of postoperative hospitalization in patients who have undergone bilateral thyroidectomy.
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Affiliation(s)
- Xiaoli Jin
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiankang Shen
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tao Liu
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ru Zhou
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xunbo Huang
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tianxiang Wang
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weize Wu
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingliang Wang
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongli Xie
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianming Yuan
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
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