Impact of Vitamin D Deficiency on Short- and Long-Term Mortality in Patients Receiving Hip Fracture Surgery Under General Anesthesia: A Matched Cohort Study.

Abstract

Although vitamin D deficiency (VDD) is common in patients who have hip fractures, the relationship between VDD and mortality risk remains unclear. Using a network database (2010 to 2023), we conducted a matched cohort study of adult patients undergoing hip fracture surgery under general anesthesia. Patients were stratified according to preoperative 25-hydroxyvitamin D levels into VDD (≤ 20 ng/mL) and control groups (≥ 30 ng/mL). After 1:1 propensity score matching, 4,736 pairs were analyzed. The primary outcome was 12-month all-cause mortality. Secondary outcomes included 30- and 90-day all-cause mortality. The 12-month mortality rate was significantly higher in the VDD group than in the control group (13.6 versus 11.6%, hazard ratio [HR]: 1.23, 95% confidence interval: 1.09 to 1.37, P = 0.0005). Similar patterns were observed at 30 days (3.4 versus 2.3%, HR: 1.52, P = 0.0007) and 90 days (7.1 versus 5.2%, HR: 1.41, P < 0.0001). Subgroup analyses based on age (18 to 65 versus > 65 years) and sex revealed a consistent association between VDD and mortality at 12 months. Vitamin D insufficiency (20 to 30 ng/mL) showed no significant association with increased mortality compared to the control group. Among patients who had VDD, malnutrition, neoplasms, diabetes mellitus, and heart disease have been identified as risk factors for 12-month mortality. Preoperative VDD was significantly associated with increased mortality risk after hip fracture surgery, with particularly pronounced effects in the early postoperative period. These findings highlight the importance of preoperative vitamin D screening and potential supplementation strategies for patients who have vitamin D levels below 20 ng/mL.