ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Preoperative Vitamin D insufficiency increases the risk of delayed neurocognitive recovery via acute systemic inflammation in elderly women undergoing gynecological surgery
Ju Bao 1
Hua-Ping Zhao 2
Ye Lu 1
Dong-Liang Mu 1
Ting Ding 1
1. First Hospital, Peking University, Beijing, China
2. The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
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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], P= 0.035). After adjustment of confounders, both VDI (OR 4.905, 95% CI 1.079-22.307, P= 0.040) and postoperative NLR / preoperative NLR (OR 3.775, 95% CI 1.398-10.192, P= 0.009) which reflect acute systemic inflammation change were associated with an increased risk of DNR. Mediation analysis showed that the effect of VDI on DNR was significantly mediated by acute systemic inflammation (adjusted β 3.2%, 95% CI 0.000% to 7.000%, P= 0.045) which accounted for 15.2% of the total effect. Conclusions: 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.
Summary
Keywords
Acute systemic inflammation, delayed neurocognitive recovery, elderly woman, Mediation analysis, Vitamin D insufficiency
Received
13 May 2025
Accepted
26 January 2026
Copyright
© 2026 Bao, Zhao, Lu, Mu and Ding. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ting Ding
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