An Assessment of the Preoperative Vitamin D Levels in Patients Undergoing Limb Lengthening Surgery.

Abstract

Vitamin D is important for skeletal health and may influence bone regeneration during distraction osteogenesis. Although vitamin D insufficiency and deficiency are common in patients undergoing limb reconstruction, the relationship between baseline vitamin D status and regenerate healing remains unclear, particularly within clinical pathways where vitamin D testing is performed perioperatively and supplementation is initiated after surgery for low levels. This study determined the prevalence of perioperative vitamin D deficiency in pediatric patients undergoing limb reconstruction for deformity correction or limb length discrepancy and evaluated the association between baseline vitamin D status, bone-healing outcomes, and postoperative complications within this real-world testing and supplementation pathway. We performed a retrospective review of pediatric patients treated from January 2017 to December 2021 for lower-extremity limb-length discrepancy using an internal lengthening nail. Serum vitamin D levels were obtained perioperatively, typically on the day of surgery, and were not used to determine surgical eligibility or timing. Patients were categorized by preoperative serum vitamin D level as deficient, insufficient, or sufficient. Patients with vitamin D insufficiency or deficiency were routinely started on postoperative supplementation. Bone healing was assessed using the Bone Healing Index (BHI), and complication rates were compared across groups. Seventy-five patients were included. Twenty-two patients (29%) were vitamin D deficient, 30 (40.0%) were vitamin D insufficient, and 23 (31%) were vitamin D sufficient. Demographic characteristics were similar among groups. Complications occurred in 3 of 22 deficient patients (14%), 2 of 30 insufficient patients (7%), and 2 of 23 sufficient patients (9%), with no difference among groups (P=0.79). Baseline vitamin D level was not significantly correlated with BHI. Sensitivity analyses excluding tibial cases and grouping patients as sufficient versus insufficient/deficient produced findings consistent with the primary analysis. Vitamin D insufficiency and deficiency were common in this pediatric limb-lengthening cohort. Within a perioperative vitamin D testing and postoperative supplementation pathway for insufficiency or deficiency, low baseline vitamin D status was not associated with lower BHI or increased postoperative complications. Level III-retrospective comparative study.