Preoperative Serum 25-Hydroxyvitamin D Level,a Risk Factor for Postoperative Cognitive Dysfunction in Elderly Subjects Undergoing Total Joint Arthroplasty

Background

Postoperative cognitive dysfunction (POCD) is a very common postoperative complication occurring mainly after high-risk surgery, especially in the elderly individuals. This study aimed to investigate potential risk factors for POCD in elderly patients after total joint arthroplasty (TJA).

Materials and Methods

A total of 257 eligible elderly patients (≥65 years) who were scheduled for elective TJA for osteoarthritis with general anesthesia were enrolled. An experienced psychiatrist was invited to evaluate the cognitive function at baseline (1 day before the surgery) and at day 7 after the surgery. Univariate and multiple logistic regression analyses were performed to screen risk factors associated with POCD. Receiver-operating characteristic curve analysis was performed to assess the predictive value of serum 25-hydroxyvitamin D [25(OH)D] expression for POCD.

Results

Of all the 257 enrolled patients, 55 (21.4%) developed POCD within 7 days after the surgery. Serum 25(OH)D level was the only independent risk factor associated with POCD (odds ratio: 1.77, 95% confidence interval: 1.13-2.78, P?=?0.016) by multiple logistic regression analysis. The area under the curve of 25(OH)D for POCD was 0.687, with the cut-off value of 11.2 ng/mL, sensitivity of 41.82% and specificity of 78.71% respectively (95% confidence interval: 0.617-0.757, P < 0.001).

Conclusions

Our results revealed that preoperative serum 25(OH)D level was an independent risk factor for POCD in elderly subjects after TJA.