Work

Preoperative vitamin D insufficiency increases the risk of delayed neurocognitive recovery via acute systemic inflammation in elderly women undergoing gynecological surgery

Year: 2026

Type: article

Abstract: Background Delayed neurocognitive recovery (DNR) is common among elderly women following gynecological surgery. This patient group is also prone to vitamin D insufficiency (VDI). Present study was designed to investigate the association between preoperative VDI and DNR in elderly female patients undergoing major gynecological surgery. Methods In this prospective cohort study, elderly women (≥65 years) scheduled for major gynecological surgery under general anesthesia were enrolled. The primary outcome was the incidence of DNR on the fifth day, which was assessed using the Montreal cognitive assessment (MoCA). VDI was defined as serum 25-hydroxyvitamin D levels <50 nmol/L. The acute change in systemic inflammatory response was reflected by the ratio of postoperative neutrophil-to-lymphocyte ratio (NLR) to preoperative NLR. The association between VDI and DNR was analyzed using multivariable logistic regression. Mediation analysis was conducted to explore the relationships among VDI, acute systemic inflammation, and DNR. Results A total of 156 patients were enrolled with mean vitamin D concentration 37.6 ± 18.7 nmol/L. 115 (73.7%) patients were classified as VDI. VDI patients suffered higher incidence of DNR than non-VDI patients [22.6% (26/115) vs. 7.3% (3/41), p = 0.035]. After adjustment of confounders, both VDI (OR 4.905, 95% CI 1.079–22.307, p = 0.040) and postoperative NLR/preoperative NLR (OR 3.775, 95% CI 1.398–10.192, p = 0.009) which reflect acute systemic inflammation change were associated with an increased risk of DNR. Mediation analysis showed that the effect of VDI on DNR was significantly mediated by acute systemic inflammation (adjusted β 3.2, 95% CI 0.000 to 7.000%, p = 0.045) which accounted for 15.2% of the total effect. Conclusion Among elderly women, preoperative VDI correlates with an elevated risk of DNR after major gynecological surgery. Acute systemic inflammatory responses may have served as a partial mediator in this correlation. Clinical trial registration www.chictr.org.cn , identifier ChiCTR2000033130.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1626647

Authors: Ju Bao, Di Zhu, Hua-Ping Zhao, Ye Lu, Dong-Liang Mu, Ting Ding

Institutions: Peking University First Hospital, First Affiliated Hospital of Zhengzhou University, Outcomes Research Consortium

Language: English

Topic: Vitamin D Research Studies

Subfield: Pathology and Forensic Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801