Non-Significant Correlation of Vitamin D Deficiency and Five-Year Revisions Following Adult Spinal Deformity Surgery After Controlling for Osteoporosis: A National Database Analysis.

Abstract

Vitamin D deficiency has been linked to poor outcomes after spinal deformity correction, but it is unclear whether osteoporosis is the underlying factor. This study analyzed a national administrative database to clarify this association. The 2010 to Q1 2022 PearlDiver M161 database was queried for adult spinal deformity surgeries. Patients were stratified by not having versus having vitamin D deficiency diagnosis and matched 4:1 based on age, sex, and Charlson Comorbidity Index (CCI), and multivariate analysis (controlling for age, sex, and CCI) for 90-day postoperative adverse events was used to calculate odds ratios (ORs, Bonferroni correction, α < 0.00417). These methods were then repeated adding osteoporosis to the matching and multivariate controlling variables. Kaplan-Meier analysis comparing 5-year cumulative revision surgery rates was also performed for both sets of comparisons. In the primary analyses matching for age, sex, and CCI, the vitamin D deficiency cohort showed a higher likelihood of osteoporosis. Multivariate analysis demonstrated that vitamin D deficiency was associated with increased odds of aggregated any (OR 1.34) and minor adverse events (1.39), as well as wound dehiscence (OR 1.91). The vitamin D deficiency group had a higher 5-year revision surgery rate (39.3% vs. 31.7%, P = 0.006).When osteoporosis was included as a matched/controlled variable, vitamin D deficiency was only associated with higher odds of aggregate any (OR 1.35) adverse events and urinary tract infection (OR 1.56). No difference in 5-year revision surgery rates was observed. Following adult deformity surgery, many of the perioperative adverse outcomes were similar regardless of controlling for osteoporosis, but 5-year revisions seemed to be driven by the osteoporosis rather than vitamin D deficiency.