Association between preoperative 25-hydroxyvitamin D3 levels and postoperative delirium in pediatric patients undergoing general anesthesia for laparoscopic surgery: a single-center retrospective study.

BACKGROUND: Postoperative delirium (POD) is a common complication after pediatric general anesthesia, impairing recovery. While vitamin D deficiency (VDD) is linked to POD in adults, its role in children remains unclear. This study investigates the association between preoperative 25-hydroxyvitamin D3 [25(OH)D3] levels and POD in children undergoing laparoscopic surgery under general anesthesia. METHODS: This single-center retrospective study enrolled 320 pediatric patients. Demographic, surgical, anesthetic, and laboratory data were collected. Preoperative serum 25(OH)D3 was measured, and POD was assessed using the Cornell Assessment of Pediatric Delirium (CAPD) scale on postoperative days 1, 3, and 7. Meanwhile, patients were categorized into VDD (<30 ng/mL) and non-VDD (≥30 ng/mL) groups. Multivariable logistic regression identified independent risk factors for POD. RESULTS: The incidence of POD was 80.3% (257/320) based on the CAPD score ≥9. POD patients had significantly lower serum 25(OH)D3 levels (P<0.05). In multivariable analysis, preoperative VDD was independently associated with a significantly higher risk of POD [adjusted odds ratio (OR) =14.25; 95% confidence interval (CI): 3.33-61.0; P<0.001]. A sensitivity analysis incorporating postoperative sleep quality [Children's Sleep Habits Questionnaire (CSHQ) score] confirmed the robustness of this association (OR =8.15; 95% CI: 1.88-35.3; P=0.005). The area under the receiver operating characteristic (ROC) curve for 25(OH)D3 in identifying POD was 0.613. CONCLUSIONS: Preoperative VDD is independently associated with a substantially increased risk of POD in pediatric patients undergoing general anesthesia for laparoscopic surgery. Preoperative screening for VDD may help identify at-risk children, and randomized controlled trials are warranted to evaluate whether preoperative vitamin D supplementation reduces POD incidence.