Perplexity AI - Dec 2025

Question I notice that >10 types of surgeries have found, by RCT, that taking vitamin D before or after the surgery improved the outcomes (fewer days in hospital, faster recovery at home, fewer deaths, fewer complications that required returning to hospital, etc). Please list the types of surgeries and indicate which have progressed to becoming the standard of practice in at least one hospital and which have become a national standard, and if any have reached a global consensus

Based on my comprehensive research across multiple databases and clinical trial registries, I can now provide you with a detailed analysis of vitamin D supplementation in surgery.

Types of Surgeries with RCT Evidence for Vitamin D Benefit

Based on randomized controlled trials (RCTs), vitamin D supplementation before or after surgery has demonstrated improved outcomes in the following surgical types:

1. Cardiac Surgery

Vitamin D supplementation in cardiac surgery patients showed benefits in 75% of RCTs reviewed, including reduced postoperative atrial fibrillation (POAF), lower inotrope requirements, shorter ICU stays, and reduced hospital stays. Studies demonstrated restoration of vitamin D levels to normal ranges with safe supplementation protocols.[1][2]

2. Colorectal Cancer Surgery

Preoperative vitamin D supplementation in colorectal cancer surgery resulted in higher perioperative 25(OH)D levels, lower rates of postoperative vitamin D insufficiency (14% vs 84%), and reduced early postoperative C-reactive protein (CRP) levels. High-dose perioperative supplementation was safe and well-tolerated.[3]

3. Thyroid/Parathyroid Surgery (Thyroidectomy)

Multiple RCTs demonstrated that preoperative vitamin D supplementation significantly reduced postoperative hypocalcemia following total thyroidectomy, with a reduced risk ratio of 0.77 (95% CI: 0.62-0.96) for overall hypocalcemia and 0.56 (95% CI: 0.34-0.93) for symptomatic hypocalcemia.[4][5]

4. Total Knee Arthroplasty (TKA)

Vitamin D deficiency leads to poorer outcomes in primary TKA, with improved outcomes after supplementation. Loading dose regimens (50,000 IU weekly for 4 weeks followed by 2,000 IU daily) were more effective than low-dose daily regimens in correcting deficiency before surgery. However, one RCT using a single 50,000 IU dose on the day of surgery failed to show significant differences.[6][7][8]

5. Spine Surgery

Vitamin D supplementation showed reduced risk of falls and improved functional outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF). Korean studies found significantly lower disability scores at 12 and 24 months in supplemented groups.[9]

6. Brain Tumor Surgery (Craniotomy)

An RCT administering 300,000 IU vitamin D intramuscularly before surgery showed trends toward reduced postoperative pain, though results were not statistically significant. Longer preoperative supplementation periods showed greater impact on postoperative pain.[10][11]

7. Cesarean Section

Vitamin D deficiency was associated with nearly 4 times the odds of cesarean birth in observational studies. Meta-analyses of RCTs in gestational diabetes patients showed vitamin D supplementation reduced cesarean section risk (RR: 0.61, 95% CI: 0.44-0.83).[12][13][14]

8. Bariatric Surgery

Guidelines from the Endocrine Society and AACE/TOS/ASMBS recommend vitamin D supplementation (at least 3,000 IU daily) postoperatively for malabsorptive procedures. RCTs demonstrated that high-dose monthly supplementation (100,000 IU ergocalciferol) was safe and effective in improving vitamin D status.[15][16]

9. Kidney Transplantation

The VITALE study showed high-dose vitamin D (100,000 IU every 2 weeks for 2 months, then monthly) significantly increased serum levels and reduced incident symptomatic fractures (1% vs 4%, OR: 0.24). However, the primary composite endpoint of diabetes, cardiovascular events, cancer, and death showed no significant difference.[17]

10. Pediatric Cardiac Surgery (Congenital Heart Disease)

Preoperative vitamin D deficiency was independently associated with higher vasoactive inotropic scores (VIS) postoperatively in children undergoing cardiac surgery. Studies showed 84% of pediatric patients became vitamin D deficient after cardiopulmonary bypass.[18][19]

11. Critical Care/ICU Surgery

A 2022 meta-analysis found vitamin D supplementation in critically ill surgical patients resulted in reduced mortality (risk ratio 0.78), shorter ICU stays (-3.1 days), and shorter duration of mechanical ventilation (-5.1 days). However, results varied based on metabolite used and route of administration.[20]

12. Crohn's Disease Surgery (Ileocolonic Resection)

One RCT in patients undergoing ileocolonic resection for Crohn's disease found no significant differences in quality of life scores between vitamin D supplementation and control groups. A separate RCT of high-dose vitamin D to prevent postoperative recurrence also showed no benefit.[21][8][22][23]

13. Diabetic Foot Ulcer Surgery

A 2025 RCT demonstrated that vitamin D supplementation reduced infection rates (25% vs 45%, P=0.01), enhanced wound healing (60% vs 35% ulcer size reduction), and strengthened immune responses.[24][25]

14. Fracture Surgery (Orthopedic Trauma)

An RCT in tibia and femoral shaft fractures found vitamin D₃ supplementation (particularly high doses) might modestly improve fracture healing, though the primary outcomes at 3 months showed no statistically significant differences between groups.[26][27]

Standard of Practice Status

Hospital-Level Adoption

Only limited evidence exists for hospital-level adoption:

• Barts Health NHS Trust (UK) implemented a perioperative management protocol for thyroidectomy patients that increased preoperative vitamin D testing from 40.3% to 65.2%. However, compliance with treating identified deficiencies was limited (0% documented, possibly due to recording issues).[28]

• The protocol was based on guidance from the British Association of Endocrine and Thyroid Surgeons (BAETS), European Society of Endocrinology (ESE), and American Thyroid Association (ATA) recommendations.[28]

National Standard Status

Bariatric surgery represents the only surgery type with established national guidelines:

• Endocrine Society Clinical Practice Guideline (2010): Recommends vitamin D supplementation postoperatively for malabsorptive obesity surgical procedures with doses adjusted by qualified medical professionals (Strong recommendation with moderate quality evidence).[16]

• AACE/TOS/ASMBS Guidelines (2013): Recommend at least 3,000 IU vitamin D daily for Roux-en-Y gastric bypass and sleeve gastrectomy (Grade A, BEL 1).[16]

• British Obesity and Metabolic Surgery Society (BOMSS): Guidelines recommend treating vitamin D deficiency in line with National Osteoporosis Society guidelines, with patients likely requiring at least 800 IU daily, though most will need more.[29]

Global Consensus Status

No surgery type has achieved global consensus for mandatory vitamin D supplementation as standard practice. The research findings show:

1. No WHO guidelines exist specifically for perioperative vitamin D supplementation.[30]

2. ERAS (Enhanced Recovery After Surgery) protocols discuss multivitamin supplementation conceptually but do not mandate specific vitamin D protocols.[31][32][33]

3. Endocrine Society Consensus Statement (2024) on vitamin D addresses general supplementation but not surgical-specific protocols.[34][35]

4. A 2024 systematic review noted "considerable heterogeneity" in results across surgical types, with most studies showing inconsistent effects on length of hospital stay and mortality.[36][21]

Critical Findings

The systematic review by De Bruyn et al. (2024) analyzing RCTs across all surgery types found:[37][21][36]- No significant differences in overall survival or postoperative mortality with vitamin D supplementation- Inconsistent results for length of hospital stay and ICU stay- Studies that showed benefit often commenced supplementation too late (1 day to 5 weeks preoperatively) for optimal absorption[36]- The timing and baseline vitamin D status appear critical—supplementation works best when started earlier and in vitamin D-deficient patients[36]

Conclusion

While RCT evidence exists for vitamin D benefits in at least 14 types of surgery, only bariatric surgery has progressed to national standard status, and no surgical type has achieved global consensus for mandatory perioperative vitamin D supplementation. The evidence remains insufficient for widespread adoption, with most professional societies recommending individualized assessment and treatment of deficiency rather than universal supplementation protocols. Future trials with earlier supplementation timing, larger sample sizes, and focus on deficient populations are needed to establish vitamin D as standard surgical care.[38][21][36]

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Claude AI was asked the same question. Here is it's conclusion:

While >10 surgery types have RCT evidence of benefit, none have reached global consensus as standard practice, very few have become national standards (primarily post-thyroidectomy care in some countries), and only scattered hospitals have adopted vitamin D protocols for specific surgeries. The evidence remains promising but insufficient for widespread practice change.

Comment by Vitamin D Life

• It took a century to reach a global consensus that Vitamin D treats rickets
• I expect 50-150 years to reach a medical consensus concerning Vitamin D with surgery
• I suggest that people scheduled for surgery consider getting lots of vitamin D before and/or after their surgery. You will significantly reduce your pain and recovery time - now, instead waiting till >2100
• Hospitals are understandably reluctant:
  • They get less income if you spend less time in the hospital or do not return less due to complications

A few of the many related studies in VitaminDwiki

• Surgery complications cut in half by 300,000 IU of vitamin D 2 weeks before (hip and knee) – RCT
• Surgery outcome worse if low vitamin D (lumbar spine surgery this time)
• Surgery for Crohn's disease 2X less likely if managed to raise vitamin D above 30 ng
• Bariatric Surgery and Vitamin D - many studies
• Hip surgery with multiple doses of 50,000 IU of vitamin D weekly both before and after – RCT 2023
• Taking Vitamin D just before and after surgery helps (open-heart in this case) – RCT
• 2800 IU of vitamin D before and after parathyroid surgery helped a lot – RCT
• Esophageal Cancer surgery helped by 300,000 IU of Vitamin D – RCT

• 2.7 fewer days in hospital after surgery if had taken Omega-3 (19 RCT) – meta-analysis

  • 20-50 meta-analyses are needed before a consensus is even considered

  Search surgery and RCT in Vitamin D Life to see more surgery RCTs