Vitamin D Deficiency and Risk of Surgical Site Infections: A Systematic Review and Meta-Analysis

Abstract

Background/Objectives:

Surgical site infection (SSI) places a burden on the healthcare system and patients. Literature suggests that vitamin D has indirect antimicrobial effects and an association with a reduction in infections. We aim to evaluate the association between vitamin D deficiency in developing SSIs in adult surgical patients.

Methods:

Embase, Medline, Clinicaltrials.gov, WHO-ICTRP, Cochrane, Web of Science, CINAHL, Google Scholar, Cochrane Central Register of Controlled Trials, and Citations were searched. Observational studies that evaluated key question were included. The meta-analysis was carried out using bias-adjusted inverse variance heterogeneity methods. A risk of bias assessment was done using the MASTER Scale. The Doi plot and the Luis Furuya-Kanamori index were utilized to visualize and quantify the asymmetry of study effects, respectively, to evaluate publication bias. The GRADE method was utilized for assessing the certainty of evidence.

Results:

This meta-analysis included 12,737 patients from eight eligible cohort studies. The overall analysis based on vitamin D cut-off levels revealed that vitamin D deficiency (<20 ng/mL) is associated with increased odds of SSI (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 0.80–2.05; I² = 37.2%, p = 0.18). Notably, a cut-off level of <30 ng/mL is linked to even higher odds of SSI (OR: 3.84, 95% CI: 2.13–5.56; I² = 0.0%, p = 0.83).

Conclusion:

This meta-analysis found a significant association between vitamin D deficiency and an increased risk of SSI. Taken together, these studies suggest that vitamin D deficiency may play a role in SSI development. However, in order to determine if vitamin D supplementation alone will reduce the risk of a post-operative SSI, a prospective clinical trial is necessary.