Non-Significant Correlation of Vitamin D Deficiency and Five-Year Revisions Following Adult Spinal Deformity Surgery After Controlling for Osteoporosis: A National Database Analysis

BACKGROUND: Vitamin D deficiency has been linked to poor outcomes after spinal deformity correction, but it is unclear whether osteoporosis is the underlying factor. This study analyzed a national administrative database to clarify this association. METHODS: The 2010 to Q1 2022 PearlDiver M161 database was queried for adult spinal deformity surgeries. Patients were stratified by not having versus having vitamin D deficiency diagnosis and matched 4:1 based on age, sex, and Charlson Comorbidity Index (CCI), and multivariate analysis (controlling for age, sex, and CCI) for 90-day postoperative adverse events was used to calculate odds ratios (ORs, Bonferroni correction, α < 0.00417). These methods were then repeated adding osteoporosis to the matching and multivariate controlling variables. Kaplan-Meier analysis comparing 5-year cumulative revision surgery rates was also performed for both sets of comparisons. RESULTS: In the primary analyses matching for age, sex, and CCI, the vitamin D deficiency cohort showed a higher likelihood of osteoporosis. Multivariate analysis demonstrated that vitamin D deficiency was associated with increased odds of aggregated any (OR 1.34) and minor adverse events (1.39), as well as wound dehiscence (OR 1.91). The vitamin D deficiency group had a higher 5-year revision surgery rate (39.3% vs. 31.7%, P = 0.006).When osteoporosis was included as a matched/controlled variable, vitamin D deficiency was only associated with higher odds of aggregate any (OR 1.35) adverse events and urinary tract infection (OR 1.56). No difference in 5-year revision surgery rates was observed. CONCLUSION: Following adult deformity surgery, many of the perioperative adverse outcomes were similar regardless of controlling for osteoporosis, but 5-year revisions seemed to be driven by the osteoporosis rather than vitamin D deficiency.