Sickle cell disease is a life-limiting inherited hemoglobinopathy that poses inherent risk for surgical complications following cardiac operations. In this review, we discuss preoperative considerations, intraoperative decision-making, and postoperative strategies to optimize the care of a patient with sickle cell disease undergoing cardiac surgery.

Background: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. Methods: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80%) and validation (20%) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system. Results: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27%) developed new onset AF including 165/611 (27%) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm (4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92). Conclusion: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.

This exploratory study utilized a mixed-method approach to examine why some NFL players participate in deviant, and sometimes law-breaking, behavior and others do not. The qualitative findings in conjunction with Durkheimian theory provided the conceptualization of a quantitative instrument. Through a snowball sample, 104 NFL players were interviewed and surveyed. From the qualitative data, three core themes emerged: 1) deviance, 2) anomie, and 3) social ties. Within the study group, a substantial number of players had prior experience with deviant and illegal behaviors. It appeared that some level of anomie was present in a number of these players' lives. However, players that had strong ties to various social groups appeared less likely to succumb to anomie and deviance. Supporting the qualitative data, the quantitative findings revealed that anomie was one of the significant predictors of law-breaking players. It would therefore appear reasonable to suggest that some of the players were involved in behaviors that could be labeled anomic deviance. Furthermore, the findings supported the primacy of social ties/support in buffering anomie and deviance in the lives of NFL players in the study group.