5 research outputs found
Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study
Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk
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The Atacama Cosmology Telescope: Cosmology from Cross-correlations of unWISE Galaxies and ACT DR6 CMB Lensing
Abstract
We present tomographic measurements of structure growth using cross-correlations of Atacama Cosmology Telescope (ACT) DR6 and Planck cosmic microwave background (CMB) lensing maps with the unWISE Blue and Green galaxy samples, which span the redshift ranges 0.2 ≲ z ≲ 1.1 and 0.3 ≲ z ≲ 1.8, respectively. We improve on prior unWISE cross-correlations not just by making use of the new, high-precision ACT DR6 lensing maps, but also by including additional spectroscopic data for redshift calibration and by analyzing our measurements with a more flexible theoretical model. We determine the amplitude of matter fluctuations at low redshifts (z ≃ 0.2–1.6), finding
S
8
≡
σ
8
(
Ω
m
/
0.3
)
0.5
=
0.813
±
0.021
using the ACT cross-correlation alone and S
8 = 0.810 ± 0.015 with a combination of Planck and ACT cross-correlations; these measurements are fully consistent with the predictions from primary CMB measurements assuming standard structure growth. The addition of baryon acoustic oscillation data breaks the degeneracy between σ
8 and Ω
m
, allowing us to measure σ
8 = 0.813 ± 0.020 from the cross-correlation of unWISE with ACT and σ
8 = 0.813 ± 0.015 from the combination of cross-correlations with ACT and Planck. These results also agree with the expectations from primary CMB extrapolations in ΛCDM cosmology; the consistency of σ
8 derived from our two redshift samples at z ∼ 0.6 and 1.1 provides a further check of our cosmological model. Our results suggest that structure formation on linear scales is well described by ΛCDM even down to low redshifts z ≲ 1.</jats:p
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The Atacama Cosmology Telescope: Mitigating the Impact of Extragalactic Foregrounds for the DR6 Cosmic Microwave Background Lensing Analysis
Abstract
We investigate the impact and mitigation of extragalactic foregrounds for the cosmic microwave background (CMB) lensing power spectrum analysis of Atacama Cosmology Telescope (ACT) data release 6 (DR6) data. Two independent microwave sky simulations are used to test a range of mitigation strategies. We demonstrate that finding and then subtracting point sources, finding and then subtracting models of clusters, and using a profile bias-hardened lensing estimator together reduce the fractional biases to well below statistical uncertainties, with the inferred lensing amplitude, A
lens, biased by less than 0.2σ. We also show that another method where a model for the cosmic infrared background (CIB) contribution is deprojected and high-frequency data from Planck is included has similar performance. Other frequency-cleaned options do not perform as well, either incurring a large noise cost or resulting in biased recovery of the lensing spectrum. In addition to these simulation-based tests, we also present null tests on the ACT DR6 data for sensitivity of our lensing spectrum estimation to differences in foreground levels between the two ACT frequencies used, while nulling the CMB lensing signal. These tests pass whether the nulling is performed at the map or bandpower level. The CIB-deprojected measurement performed on the DR6 data is consistent with our baseline measurement, implying that contamination from the CIB is unlikely to significantly bias the DR6 lensing spectrum. This collection of tests gives confidence that the ACT DR6 lensing measurements and cosmological constraints presented in companion papers to this work are robust to extragalactic foregrounds.</jats:p
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Cosmological constraints from the tomography of DES-Y3 galaxies with CMB lensing from ACT DR4
Abstract
We present a measurement of the cross-correlation between the MagLim galaxies selected from the Dark Energy Survey (DES) first three years of observations (Y3) and cosmic microwave background (CMB) lensing from the Atacama Cosmology Telescope (ACT) Data Release 4 (DR4), reconstructed over ∼ 436 deg2 of the sky. Our galaxy sample, which covers ∼ 4143 deg2, is divided into six redshift bins spanning the redshift range of 0.20<z<1.05. We adopt a blinding procedure until passing all consistency and systematics tests. After imposing scale cuts for the cross-power spectrum measurement, we reject the null hypothesis of no correlation at 9.1σ. We constrain cosmological parameters from a joint analysis of galaxy and CMB lensing-galaxy power spectra considering a flat ΛCDM model, marginalized over 23 astrophysical and systematic nuisance parameters. We find the clustering amplitude S
8 ≡ σ
8(Ω
m
/0.3)0.5 = 0.75+0.04
-0.05. In addition, we constrain the linear growth of cosmic structure as a function of redshift. Our results are consistent with recent DES Y3 analyses and suggest a preference for a lower S
8 compared to results from measurements of CMB anisotropies by the Planck satellite, although at a mild level (< 2σ) of statistical significance. </jats:p