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

Problemi di sicurezza connessi con l'adozione di rampe nelle coltivazioni minerarie

Incontro su Prospettive di sviluppo dell'attività estrattiva, Novegro (Milano), 3 Marzo 198

Poveri e reclusi. Dagli hospitali ai ricoveri: legislazione, statuti, condizioni di vita.

Povert\ue0 e indigenza sono condizioni in cui si \ue8 trovata a vivere per lungo tempo, e in cui si trova a vivere anche oggi, gran parte della popolazione. Il volume si sofferma sulle condizioni di vita dei poveri di ieri. Poveri perch\ue9 non hanno quanto serve per garantirsi \u201cl\u2019ordinario del loro sostenere\u201d, per cui spesso sono obbligati a elemosinare e a mendicare\u201d; reclusi perch\ue9 la risposta, l\u2019unica per molto tempo, \ue8 stata la reclusione, intesa sia come negazione della loro condizione e dei loro bisogni, sia come internamento negli stabilimenti assistenziali. L\u2019evoluzione della legislazione sui poveri, l\u2019analisi degli statuti e dei regolamenti delle strutture assistenziali, i criteri utilizzati per l\u2019internamento, la vita quotidiana all\u2019interno dei ricoveri, soprattutto per anziani, sono i temi che il volume affronta, disegnando un quadro storico delle varie \u201cpolitiche sociali\u201d