Preoperative Vitamin D Level is Associated with Acute Pain After Video-Assisted Thoracoscopic Surgery: A Retrospective Cohort Study

Figures & data

Figure 1 Flowchart of patient enrollment and follow-up.

Table 1 Baseline Characteristics Based on Serum Vitamin D Level

Characteristic		Low (<30 nmol/L) (n = 73)	Sufficient (≥30 nmol/L) (n = 62)	P
Demographic characteristics	Age, y	57.5±13.1	58.8±11.8	0.554
	Sex, n (%)
	Male	34 (46.6%)	27 (43.5%)	0.725
	Female	39 (53.4%)	35 (56.5%)
	BMI, kg/m^2	23.9±2.6	23.7±3.0	0.545
	Vitamin D level, nmol/L	27.4±1.5	32.7±2.1	<0.001
	Educational time*, y	8.1±4.4	9.2±5.2	0.170
	Smokers, n (%)	13 (17.8%)	17 (27.4%)	0.181
	Hypertension, n (%)	25 (34.2%)	17 (27.4%)	0.393
	Diabetes, n (%)	3 (4.1%)	5 (8.1%)	0.469
	Coronary disease, n (%)	2 (2.7%)	2 (3.2%)	0.868
	ASA n (%)			0.204
	I	35 (47.9%)	38 (61.3%)
	II	37 (50.7%)	23 (37.1%)
	III	1 (1.4%)	1 (1.6%)
	Pain dimension of QoR-40 scale	34.4±1.5	34.7±0.7	0.115
Intraoperative data	Incision choice, n (%)			0.908
	Lobectomy	38 (52.1%)	29 (46.8%)
	Segmentectomy	19 (26.0%)	19 (30.6%)
	Wedge resection	13 (17.8%)	12 (19.4%)
	Other	3 (4.1%)	2 (3.2%)
	Regional anesthesia, n (%)			0.971
	SAPB	12 (16.4%)	11 (17.7%)
	ESPB	9 (12.3%)	8 (12.9%)
	TPVB	2 (2.7%)	1 (1.6%)
	No	50 (68.5%)	42 (67.7%)
	Sufentanil consumption, mg	61.2±15.5	56.5±15.6	0.077
	Duration of anesthesia, min	96.8±42.6	98.4±44.3	0.831
	Preoperative location, n (%)	14 (19.2%)	11 (17.7%)	0.830
	Lymph node dissection, n (%)	41 (56.2%)	35 (56.5%)	0.973
Postoperative data	Morphine consumption 48 h*, mg	56.9±22.0	56.3±22.8	0.875
	Remedial analgesics 48 h, n (%)	60 (82.2%)	44 (71.0%)	0.152
	Length of hospital stay, days	3.8±1.7	3.8±1.5	0.966
	Pathological diagnosis, n (%)			0.908
	Malignancy	63 (86.3%)	55 (88.7%)
	Other	10 (13.7%)	7 (11.3%)

Notes: Data are given as absolute numbers (n), percentage (%) of the whole population (N), and median (interquartile range), as appropriate. *Missing data: Educational time, 16; Morphine consumption 48 h, 33.

Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; ESPB, erector spinae plane block; QoR-40, Quality of Recovery-40; SAPB, serratus anterior plane block; TPVB, thoracic paravertebral block.

Table 2 The Number of Patients with Moderate-Severe Pain in the Immediate Postoperative (48 Hours) Period Stratified by Vitamin D Levels

Vitamin D Levels	N	Moderate-Severe Pain (n [%])
<30 nmol/L	73	38 (52.1%)
≥30 nmol/L	62	19 (30.6%)
Total	135	57 (42.2%)

Figure 2 (A) Unadjusted and adjusted odds ratios of moderate-severe pain. (B) Stepwise multiple logistic regression analysis of determinants for postoperative moderate-severe pain. *Adjusted for age, sex, educational time, smoking and BMI.

Table 3 Secondary Outcomes - Levels of CRP and Cytokines

	Low (<30 nmol/L) (n = 73)	Sufficient (≥30 nmol/L) (n = 62)	P
CRP, mg/L
Preoperative	3.3±0.3	3.5±1.0	0.108
POD1	38.7±21.7	34.2±24.4	0.259
POD2	86.8±36.6	81.4±36.1	0.395
Cytokines, pg/mL
IL-1
Preoperative	2.2±1.5	2.3±1.3	0.756
POD1	2.0±1.1	1.9±1.0	0.451
POD2	1.9±1.4	1.8±0.8	0.842
IL-6
Preoperative	4.5 (7.3)	4.7 (7.5)	0.812
POD1	64.6 (108.6)	51.1 (103.9)	0.139
POD2	64.6 (60.1)	37.3 (66.7)	0.101
TNF-α
Preoperative	2.3 (1.1)	2.6 (1.4)	0.257
POD1	2.7 (4.9)	2.5 (3.2)	0.541
POD2	2.6 (1.6)	2.6 (1.5)	0.466

Notes: Data are given as absolute numbers (n), percentage (%) of the whole population (N), and median (interquartile range), as appropriate.

Abbreviations: CRP, C-reactive protein; IL, interleukin; POD1, postoperative day 1; POD2, postoperative day 2; TNF-α, tumor necrosis factor-α.

Table 4 Secondary Outcomes - Pain Scores at 3 Months After Surgery

NRS 3M	Low (<30 nmol/L) (n = 73)	Sufficient (≥30 nmol/L) (n = 62)	P
Static*	0 (0.7)	0 (0.6)	0.218
Dynamic*	0 (1.4)	0 (1.0)	0.156

Notes: Data are given as absolute numbers (n), percentage (%) of the whole population (N), and median (interquartile range), as appropriate. *Missing data: Static, 27; Dynamic, 27.

Abbreviation: NRS 3M, numerical rating scale of pain 3 months after surgery.