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

## TL;DR

Low vitamin D levels before surgery increase the risk of delayed brain recovery in elderly women due to inflammation after gynecological procedures.

## Contribution

This study identifies preoperative vitamin D insufficiency as a risk factor for delayed neurocognitive recovery, mediated by acute systemic inflammation.

## Key findings

- VDI patients had a higher DNR incidence compared to non-VDI patients.
- Acute systemic inflammation partially mediated the effect of VDI on DNR.
- Both VDI and increased NLR ratio were independently associated with DNR.

## Abstract

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.

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.

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.

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.

www.chictr.org.cn, identifier ChiCTR2000033130.