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Hypovitaminosis D is common, before and after gastric bypass surgery. The prevalence of hypovitaminosis D in a large group of candidates for bariatric surgery in Brazil and South America has not been studied. To evaluate the prevalence of hypovitaminosis D and associated factors in patients undergoing bariatric surgery in Southern Brazil. Cross-sectional study involving all patients presenting for bariatric surgery at Hospital de Clinicas de Porto Alegre, from January 2013 to June 2018. Data were extracted from the patients’ electronic medical records. Patients who were taking multivitamin supplements or vitamin D supplements, who had renal insufficiency, or had missing data for 25(OH) vitamin D [25(OH)D] levels were excluded. A total of 291 patients were included. Mean subjects’ age was 44.9 (SD 10.7) years, and BMI 49.3 (SD 8.3) kg/m2; 76.6% of the study patients were women, and 87.3% were white. More than half the patients (55.3%) were vitamin D deficient (serum 25(OH)D ≤ 19.9 ng/ml), and 37.1% had insufficient levels (20–29.9 ng/mL). Mean vitamin D level was 19.2 ng/mL (SD 7.6). An inverse correlation was found between 25(OH)D levels and BMI. Vitamin D deficiency was more prevalent in patients with higher BMI [PR 1.02; CI 95% (1.00–1.03)], higher fasting glucose [PR 1.01; CI 95% (1.00–1.01)], in nonwhite patients [PR 1.58; CI 95% (1.30–1.92)] and during autumn/winter season [PR 1.41; CI 95% (1.14–1.75)]. Prevalence of vitamin D insufficiency and deficiency is very high among patients presenting for bariatric surgery in Southern Brazil, and the known associated factors are confirmed in this population.

Background: Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery. Objective: To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients. Methods: Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients’ groups: transfused and not transfused. Student's t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant. Results: Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%). Conclusion: EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality.

Low levels of 25(OH) vitamin D [25(OH)D] are frequent in obese patients undergoing bariatric surgery. Hypovitaminosis D is a concern in these patients, since it could contribute to the bone loss seen after surgery, and potentially increase fracture risk . Despite post-operative supplementation, 25(OH)D often remains below recommended levels following surgery. Guidelines recommend that vitamin D levels are determined preoperatively. Nevertheless, the systematic determination of 25(OH)D in thousands of patients every year is costly. The prevalence of low levels of 25(OH)D seems to be high among Southern Brazilians. In this scenario, it may be unnecessary to check blood levels prior to introduction of supplementation in bariatric patients. The aim of this study was to evaluate the prevalence of vitamin D deficiency and associated factors in patients undergoing bariatric surgery in Southern Brazil. This was a Cross-sectional, observational study of all patients presenting for bariatric surgery at Hospital de Clínicas de Porto Alegre (a teaching hospital), from 2013 to 2018. Clinical and laboratory data were extracted from electronic records. Patients who were taking supplements containing vitamin D, had renal insufficiency or had missing data for 25(OH)D levels were excluded. Vitamin D status was determined using established cut-offs (deficient ≤19.9 ng/ml; insufficient 20-29.9 ng/mL; sufficient ≥30 ng/mL). Factors associated with vitamin D deficiency were analysed by univariate and multivariable robust Poisson Regression. 297 patients met the inclusion criteria. Mean patient age was 44.7(SD 10.8), and BMI 49,9(SD 8.1) kg/m²; 77.1% were women, and 87.5% were white. More than half the patients (54.5%) were vitamin D deficient, whereas 37% were insufficient, and only 8.4 % had sufficient levels. Mean vitamin D level was 19.7 ng/mL(SD 7.7). Vitamin D deficiency was significantly more prevalent in patients with higher BMI [PR 1.02; CI 95% (1.00-1.03)] and in nonwhite patients [PR 1.71; CI 95% (1.43-2.04)]. Vitamin D insufficiency and deficiency is highly prevalent among patients presenting for bariatric surgery in Southern Brazil. These results are in accordance with studies in Europe and North America. Although sunnier and located in a smaller latitude, Brazil has no food fortification policy and the average vitamin D dietary intake is below the recommendation in almost 100% of its population. Thus, treatment for hypovitaminosis D might routinely be considered in bariatric surgery candidates, especially in those with characteristics identified as independent risk factors for vitamin D deficiency, such as higher BMI and being non-white. Long-term studies are required to assess the eventual advantages and side effects of systematic vitamin D supplementation in this population.

to describe, in a practical and step-by-step manner, the construction of a fully electronic platform for data collection, storage, and analysis, initially proposed for cardiovascular surgery, with interfaces that are reproducible and applicable to other surgical specialties, as well as to present the initial work experience with this instrument in cardiac surgery and the preliminary results obtained after its implementation in a Brazilian tertiary university hospital.the platform was developed based on Google tools, which are free, easy to use, and widely accessible. From the beginning of this initiative, in May 2015, to the preliminary analysis, in February 2017, data from 271 consecutive patients submitted to cardiovascular surgery were prospectively recorded and preliminarily analyzed.the initiative was implemented with full success, with 100% of patients included and without loss of any variable, in a database composed of more than 500 variables. The most frequent immediate postoperative complications were: atrial fibrillation (22.5%), bronchopneumonia (10.7%), delirium (10.3%), acute renal failure (10%), stroke (5%), and death (7%). Comparing mortality rates in the first and second years of the initiative, a reduction from 10.8% to 4% (p=0.042), respectively, was evidenced.the new proposal of data collection and storage presented in this work was fully feasible and effective. It may be useful to other surgical specialties that wish to develop methods to evaluate success and postoperative complication rates, as well as quality improvement programs.descrever de maneira prática e detalhada a criação de uma plataforma totalmente informatizada para coleta, armazenamento e análise de dados, inicialmente proposta para cirurgia cardiovascular, com interfaces reprodutíveis e aplicáveis a outras especialidades cirúrgicas, bem como, apresentar a experiência inicial de trabalho com esta ferramenta e os resultados preliminares obtidos após sua implementação em um hospital universitário terciário brasileiro.a plataforma foi desenvolvida com base nas ferramentas Google, gratuitas, de fácil utilização e amplamente acessíveis. Desde o início desta iniciativa, em maio de 2015, até a análise preliminar, em fevereiro de 2017, dados de 271 pacientes, consecutivos, submetidos à cirurgia cardiovascular foram prospectivamente recordados e analisados.a iniciativa foi implementada com pleno sucesso, com 100% dos pacientes incluídos e sem perda de qualquer variável em um banco de dados composto por mais de 500 variáveis. As complicações pós-operatórias imediatas mais frequentes foram: fibrilação atrial (22,5%), broncopneumonia (10,7%), delirium (10,3%), insuficiência renal aguda (10%), acidente vascular encefálico (5%) e morte (7%). Comparando-se as taxas de mortalidade no primeiro e segundo anos da iniciativa, uma redução de 10,8% para 4% (p=0,042), respectivamente, foi evidenciada.a nova proposta de coleta e armazenamento de dados apresentada neste trabalho mostrou-se plenamente factível e efetiva. Por serem gratuitas, de fácil manuseio e universalmente acessíveis, estas ferramentas podem ser úteis a outras especialidades cirúrgicas que desejem desenvolver métodos de avaliação de sucesso e complicações pós-operatórios, bem como, programas de melhoria de qualidade.

RESUMO Objetivo: descrever de maneira prática e detalhada a criação de uma plataforma totalmente informatizada para coleta, armazenamento e análise de dados, inicialmente proposta para cirurgia cardiovascular, com interfaces reprodutíveis e aplicáveis a outras especialidades cirúrgicas, bem como, apresentar a experiência inicial de trabalho com esta ferramenta e os resultados preliminares obtidos após sua implementação em um hospital universitário terciário brasileiro. Métodos: a plataforma foi desenvolvida com base nas ferramentas Google, gratuitas, de fácil utilização e amplamente acessíveis. Desde o início desta iniciativa, em maio de 2015, até a análise preliminar, em fevereiro de 2017, dados de 271 pacientes, consecutivos, submetidos à cirurgia cardiovascular foram prospectivamente recordados e analisados. Resultados: a iniciativa foi implementada com pleno sucesso, com 100% dos pacientes incluídos e sem perda de qualquer variável em um banco de dados composto por mais de 500 variáveis. As complicações pós-operatórias imediatas mais frequentes foram: fibrilação atrial (22,5%), broncopneumonia (10,7%), delirium (10,3%), insuficiência renal aguda (10%), acidente vascular encefálico (5%) e morte (7%). Comparando-se as taxas de mortalidade no primeiro e segundo anos da iniciativa, uma redução de 10,8% para 4% (p=0,042), respectivamente, foi evidenciada. Conclusão: a nova proposta de coleta e armazenamento de dados apresentada neste trabalho mostrou-se plenamente factível e efetiva. Por serem gratuitas, de fácil manuseio e universalmente acessíveis, estas ferramentas podem ser úteis a outras especialidades cirúrgicas que desejem desenvolver métodos de avaliação de sucesso e complicações pós-operatórios, bem como, programas de melhoria de qualidade.