ArticleFrontiers in medicine2026
Preoperative vitamin D insufficiency increases the risk of delayed neurocognitive recovery via acute systemic inflammation in elderly women undergoing gynecological surgery.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: 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. Methods: 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. Results: 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), Conclusion: 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. Clinical trial registration: www.chictr.org.cn, identifier ChiCTR2000033130.
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