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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.info:eu-repo/semantics/publishedVersio

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Pentoxifylline and electromagnetic field improved bone fracture healing in rats

Yusuf Atalay,1 Nedim Gunes,2 Mehmet Dervis Guner,3 Veysi Akpolat,4 Mustafa Salih Celik,4 Rezzan Guner21Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakir, 3Department of Orthopedics, Medicana Hospitals, Ankara, 4Department of Biophysics, Faculty of Medicine, Dicle University, Diyarbakir, TurkeyBackground: The aim of this study was to evaluate the effects of a phosphodiesterase inhibitor pentoxifylline (PTX), electromagnetic fields (EMFs), and a mixture of both materials on bone fracture healing in a rat model.Materials and methods: Eighty male Wistar rats were randomly divided into four groups: Group A, femur fracture model with no treatment; Group B, femur fracture model treated with PTX 50 mg/kg/day intraperitoneal injection; Group C, femur fracture model treated with EMF 1.5&plusmn;0.2 Mt/50 Hz/6 hours/day; and Group D, femur fracture model treated with PTX 50 mg/kg/day intraperitoneal injection and EMF 1.5&plusmn;0.2 Mt/50 Hz/6 hours/day.Results: Bone fracture healing was significantly better in Group B and Group C compared to Group A (P&lt;0.05), but Group D did not show better bone fracture healing than Group A (P&gt;0.05).Conclusion: It can be concluded that both a specific EMF and PTX had a positive effect on bone fracture healing but when used in combination, may not be beneficial.Keywords: bones, electromagnetic fields, fracture healing, phosphodiesterase inhibitor, pentoxifylline, rat

Magneto-optical and catalytic properties of Fe3O4@HA@Ag magnetic nanocomposite

Fe3O4@HA@Ag magnetic nanocomposites (MNCs) were successfully synthesized by the simple reflux method for the removal of azo dyes from the industrial aqueous media. Fe3O4@HA@AgMNCs exhibited high catalytic activity to reduce MB within 20 min from the waste water. The obtained materials were characterized by the means of different techniques. Powder X-ray diffraction(XRD) analysis confirmed the single-phase of Fe3O4 spinel structure. SEM and TEM analysis indicated that Fe3O4@HA@AgMNCs were nanoparticles like structure with small agglomeration. TG result showed that the products contained 9% of HA. The characteristic peaks of HA at 1601 cm(1) and 1703 cm(1) was observed by the means of FT-IR spectra of Fe3O4@HA@AgMNCs. The hysteresis(sigma-H) curves revealed Fe3O4@HA@AgMNCs exhibit a typical superparamagnetic characteristic with a saturation magnetization of 59.11 emu/g and measured magnetic moment is 2.45 mu(B). The average magnetic particle dimension(D-mag) is 13.25 nm. In accordance, the average crystallite and particle dimensions were obtained as 11.50 nm and 13.10 nm from XRD and TEM measurements, respectively. Magnetocrystalline anisotropy was offered as uniaxial and calculated effective anisotropy constant(K-eff) is 2.96 x 10(5) Erg/g. The blocking temperature was estimated as 522K. The size-dependent saturation magnetization suggests the existence of a magnetically dead layer as 0.793 nm for Fe3O4@HA@AgMNCs. The UV-vis diffuse reflectance spectroscopy (DRS) and Kubelka-Munk theory were applied to determine the optical properties of powder samples. The direct optical energy band gap(E-g) values were estimated from Tauc plots between 1.62 eV and 2.12 eV. (c) 2016 Elsevier B.V. All rights reserved

Magneto-optical properties and Mossbauer Investigation of BaxSryPbzFe12O19 Hexaferrites

Ba0.3Sr0.4Pb0.3Fe12O19, Ba(0.4)Sro(0.3)Ph(0.3)Fe(12)O(19) and Ba0.3Sr0.3Pb0.4Fe12O19 hexaferrites were synthesized via sol-gel auto combustion. XRD (X-ray powder diffraction) powder patterns of the products confirmed the formation of M-type hexaferrites without any secindary phase. The crystallite sizes of the products were calculated as 3741 nm by Scherrer equation. SEM (Scanning electron microscopy) analyses revelaed the hexagonal morphology and 200-400 nm grain size of the prodcuts. The magnetic hysteresis (a sigma-H) curves exhibit the ferromagnetic features for all hexaferrites. Especially, Ba0.3Sr0.4Pb0.3Fe12O19 and Ba0.4Sr0.3Pb0.3Fe12O19 samples have suitable magnetic characteristics (saturation magnetizations as 42.58 and 38.55 emu/g, coercive fields as 1950 and 2978 Oe, larger squareness ratios (SQR) as 0.447 and 0.454, respectively) for high density magnetic recording applications and permanent magnet fabrication. Effective crystalline anisotropy constants (Kell) are between 3.18x10(5) -3.54x10(5) Erg/g. The observed 17000 Oe Ha (anisotropy field) reveal that products are hard magnet. Tauc plots were plotted to determine the Eg (direct optical energy band gap) of the samples. The Eg values are 1.46, 1.51, 1.69 eV belonging to Ba0.3Sr0.4Pb0.3Fe12O19, Ba0.4Sr0.3Pb0.3Fe12O19, and Ba0.3Sr0.3Pb0.4Fe12O19 hexaferrites respectively