The effect of preoperative anemia on the outcome after coronary surgery

Abstract Background: Preoperative anemia is associated with increased morbidity and mortality after cardiac surgery. Since anemia is ultimately treated with red blood cell transfusions, we investigated the independent impact of anemia and transfusion on the outcome after coronary artery bypass grafting (CABG). Methods: This study included 2761 consecutive patients who underwent isolated CABG. Anemia was defined as hemoglobin <12.0 g/dL in women and <13.0 g/dL in men. The main outcomes were 30-day and late mortality. Results: Patients with preoperative anemia had an increased prevalence of significant comorbidities and were associated with higher unadjusted risk of early and late adverse events. Propensity score matching resulted in 560 pairs with similar baseline and operative characteristics. In these matched pairs, anemic patients had an increased risk of late all-cause death (P = 0.047) and acute kidney injury (P < 0.0001). However, when adjusted for the severity of perioperative bleeding, preoperative anemia was not associated with an increased mortality risk (HR 1.10, 95% CI 0.86–1.39). Instead, this regression model showed that the European CABG registry (E-CABG) bleeding classification was an independent predictor of late mortality (compared to grade 0: grade 1, HR 1.93, 95% CI 1.37–2.73, grade 2, HR 2.19, 95% CI 1.50–3.18, grade 3, HR 5.59, 95% CI 3.34–9.39, P < 0.0001). Conclusions: When adjusted for important baseline characteristics and operative factors as well as for the severity of perioperative bleeding and the amount of transfused blood products, anemia was not associated with an increased risk of adverse events. Increased exposure to blood transfusion among anemic patients may be the determinant of their poorer late survival

Outcome after procedures for retained blood syndrome in coronary surgery

Abstract OBJECTIVES: Incomplete drainage of blood from around the heart and lungs can lead to retained blood syndrome (RBS) after cardiac surgery. The aim of this study was to assess the incidence of and the outcome after procedures for RBS in patients undergoing isolated coronary artery bypass grafting (CABG). METHODS: A total of 2764 consecutive patients who underwent isolated CABG from 2006 to 2013 were investigated retrospectively. Patients undergoing any procedure for RBS were compared with patients who did not undergo any procedure for RBS. Multivariate analyses were performed to assess the impact of procedures for RBS on the early outcome. RESULTS: A total of 254 patients (9.2%) required at least one procedure for RBS. Multivariate analysis showed that RBS requiring a procedure for blood removal was associated with significantly increased 30-day mortality [8.3% vs 2.7%, odds ratio (OR) 2.11, 95% confidence interval (95% CI) 1.15–3.86] rates. Procedures for RBS were independent predictors of the need for postoperative antibiotics (51.6% vs 32.1%, OR 2.08, 95% CI 1.58–2.74), deep sternal wound infection/mediastinitis (6.7% vs 2.2%, OR 3.12, 95% CI 1.72–5.66), Kidney Disease: Improving Global Outcomes acute kidney injury (32.7% vs 15.3%, OR 2.50, 95% CI 1.81–3.46), length of stay in the intensive care unit (mean 8.3 vs 2.0 days, beta 1.74, 95% CI 1.45–2.04) and composite major adverse events (21.3% vs 6.9%, OR 3.24, 95% CI 2.24–4.64). These findings were also confirmed in a subgroup of patients with no pre- or postoperative unstable haemodynamic conditions. CONCLUSION: RBS requiring any procedure for blood removal from pericardial and pleural spaces is associated with an increased risk of severe complications after isolated CABG

Sediment and Phosphorus Transport in Irrigation Furrows

Sediment and phosphorus (P) in agricultural runoff can impair water quality in streams, lakes, and rivers. We studied the factors affecting P transfer and transport in irrigated furrows in six freshly tilled fallow fields, 110 to 180 m long with 0.007 to 0.012 m m' slopes without the interference of raindrops or sheet flow that occur during natural or simulated rain. The soil on all fields was Portneuf silt loam (coarse-silty, mixed, superactive, mesic Durinodic Xeric Haplocalcids). Flow rate, sediment concentration, and P concentrations were monitored at four, equally spaced locations in each furrow. Flow rate decreased with distance down the furrow as water infiltrated. Sediment concentration varied with distance and time with no set pattern. Total P concentrations related directly to sediment concentrations (r2 = 0.75) because typically >90% of the transported P was particulate P, emphasizing the need to control erosion to reduce P loss. Dissolved reactive phosphorus (DRP) concentrations decreased with time at a specific furrow site but increased with distance down the furrow as contact time with soil and suspended sediment increased. The DRP concentration correlated better with sediment concentration than extractable furrow soil P concentration. However, suspended sediment concentration tended to not affect DRP concentration later in the irrigation (>2 h). These results indicate that the effects of soil P can be overshadowed by differences in flow hydraulics, suspended sediment loads, and non-equilibrium conditions

Alterações no teor de fósforo no solo com aplicação de dejetos líquidos de suínos Soil phosphorus alteration by pig slurry application

Os dejetos líquidos de suínos servem como fonte de nutrientes às plantas, porém, quando o seu uso é inadequado, podem causar o acúmulo de P no solo, que posteriormente pode ser transferido para o meio aquático, causando eutrofização. Este trabalho teve por objetivo avaliar o potencial de risco de contaminação ambiental com o uso de dejeto líquido de suíno, mensurando as alterações ocorridas no teor de P no solo e nas isotermas de sorção. O trabalho foi realizado na Universidade Federal de Santa Maria, RS, em um Argissolo Vermelho distrófico arenico. Foram utilizadas as doses de 0, 40 e 80 m³ ha-1 de dejetos líquidos de suínos, distribuídos a lanço sobre a superfície antes da semeadura de cada espécie numa rotação de culturas. A aplicação de dejeto líquido de suínos na superfície do solo sob sistema plantio direto, aportando quantidades de P superiores àquelas exportadas pelas culturas, aumentou o P disponível do solo até 15 cm de profundidade. A saturação dos sítios de adsorção de fosfato do solo, avaliada pelos parâmetros de equação de Langmuir, é proporcional à dose de dejetos líquidos de suínos. A concentração de P na solução de equilíbrio P, a quantidade de P dessorvida com água e a constante que pode dar informação sobre a afinidade do fosfato com o solo da superfície foram alteradas pela aplicação de dejetos líquidos de suínos, indicando um favorecimento à dessorção de P caso estes sejam erodidos para mananciais de águas superficiais.<br>Pig slurry serves as plant nutrient source, but may cause phosphorus accumulation in the soil when used improperly, which later can be transferred to the aquatic environment causing eutrophication. The objective of this study was to evaluate the potential risk of environmental contamination by continuous use of pig slurry, measuring alterations in phosphorus content in the soil and in the sorption isotherms. The study was carried out at the Universidade Federal de Santa Maria, in a Typic Hapludalf. The effects of applying 0, 40 and 80 m³ ha-1 pig slurry broadcast over the soil surface before sowing of each species in a crop rotation were studied. The pig slurry, applied on the soil surface under no tillage, contained phosphorus quantities superior to those exported by crops, which increased the available soil phosphorus to a depth of 15 cm. The saturation of the soil phosphate adsorption sites, as indicated by the parameters of the Langmuir equation, was proportional to the pig slurry rate. The pig slurry application altered the concentration of phosphorus in the equilibrium solution, the amount of phosphorus desorbed with water and the constant describing the affinity of phosphate for the substratum surface. The observed changes point to a risk of phosphorus desorption in case the sediments are transferred to surface water bodies