Association Between Vitamin D Deficiency and Adverse Events Following Shoulder Surgeries: A Systematic Review and Meta-analysis.

Background and objectives: The impact of Vitamin D deficiency on postoperative outcomes following orthopaedic surgeries has been a topic of great interest over the past decade. We aimed to investigate whether vitamin D deficiency is associated with an increased rate of adverse events following rotator cuff repairs (RCR) and total shoulder arthroplasties (TSA).

Materials and methods: PUBMED and SCOPUS databases were searched from February to May 2023 for studies investigating the association between vitamin D deficiency and adverse events following RCR and TSA. Studies were eligible for inclusion if they: (1) were observational cohort studies or case-control studies, (2) included preoperative Vitamin D levels or ICD-9/ICD-10 codes appropriate for Vitamin D deficiency, (3) provided an effect estimate with its Odds Ratio (OR) and 95% confidence intervals (CI), (4) were available in English. Adverse events included rotator cuff retears following RCR, and revision surgeries for any reason following RCR or TSA. Publication bias was assessed using Begg's and Egger's tests. Data from eligible studies was extracted and pooled OR with 95% CI were calculated using STATA version 15.

Results: Four publications were included, reporting 4 independent cohort studies with > 41,000 subjects. Vitamin D deficient patients were 1.2 times more likely to experience adverse events following RCR or TSA than those without Vitamin D deficiency (OR: 1.23, 95% CI: 1.14-1.34, p < 0.001). The subgroup analysis of studies evaluating only RCRs revealed that the likelihood of adverse events following RCR was higher in vitamin D deficient patients than those without vitamin D deficiency (OR: 1.19, 95% CI: 1.09-1.29, p = 0.019).

Conclusions: Vitamin D deficiency accounts for higher rates of adverse events following RCR and TSA. However, further research is required to identify the underlying pathophysiology involved in this association between Vitamin D deficiency and adverse events following shoulder surgeries.

Level of evidence: IV.