Vitamin D Deficiency Before Single-Level Lumbar Fusion is Linked to More Postoperative Complications: A Large Propensity Matched Retrospective Cohort Analysis

Introduction: Vitamin D is essential for bone metabolism, yet there remains inconclusive evidence regarding its influence on postoperative outcomes following spine surgery. This study aims to investigate the association between preoperative vitamin D deficiency and the incidence of postoperative complications in patients undergoing single-level lumbar fusion.

Methods: The TriNetX database was queried using CPT codes and ICD codes for patients ages 18-100 who underwent a single-level lumbar fusion surgery. Patients were further categorized by those with a preoperative Vitamin D deficiency between 1 year and 1 day before surgery (n=167,149) and those without (n=10,900). These cohorts were propensity matched for demographics and comorbidities, resulting in 10,898 patients in each of the two cohorts. 90-day medical complications and 1-and-3-year surgical complications were analyzed. Risk difference, relative risk, and odds ratio were performed for each outcome within the TriNetX system. Statistical significance was set to p< 0.05.

Results: atients with Vitamin D deficiency prior to a single-level lumbar spinal fusion had significantly higher 90-day risk of ED utilization (p < 0.0001), DVT (p < 0.0001), PE (p = 0.0045), pneumonia (p < 0.0001), acute renal failure (p = 0.0026), UTI (p < 0.0001), urinary retention (p = 0.0135), SSSI (p = 0.0017), sepsis (p = 0.0314), unspecified infection (p = 0.0448), hardware failure (p = 0.0032), and pseudoarthrosis (p < 0.0001), significantly higher 1 and 3-year risk of hardware failure (p < 0.0001) and pseudarthrosis (p < 0.0001), and a significantly higher 3-year risk of revision surgery (p = 0.0040).

Conclusion : Preoperative vitamin D deficiency may be a significant predictor of adverse medical and surgical outcomes following single-level lumbar fusion. There may be potential benefit for routine screening and management of vitamin D deficiency in patients before spinal fusion surgery to potentially improve postoperative outcomes.