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

The Origin and MgCl2–NaCl Variations in an Athalassic Sag Pond: Insights from Chemical and Isotopic Data

The examination of past and new chemical–isotopic data (2H/1H–18O/16O,11B/10B and87Sr/86Sr ratios) shows the meteoric origin of the Sawa Lake (Muthanna Governorate, Iraq) and its connection with the local aquifers, which feed the lake via the groundwater emerging from its floor through fault systems. The chemical and isotopic evaporation models are traced by geochemical computer codes by using a different composition of some potential inflows to the lake (e.g., the Euphrates River and Dammam aquifer). The main product of the chemical evaporation models is gypsum, as confirmed by the mineralogical examination of the sediment and the surrounding outcrops. A strong18O–2H enrichment is a consequence of the evaporation effect in arid regions; δ18O–Cl models and δ11B = + 23.4‰ exclude the contribution of any seawater-derived fluids. This latter value along with87Sr/86Sr = 0.707989 suggests a mixed origin from the Eocene–Miocene aquifers. The isotope and chemical evaporation paths from the meteorically recharged sources match the lake composition. However, compositional switches from NaCl toward MgCl2occurred in the last decade and are related to post-drought periods, showing that the interaction of the recharging waters with the local soils (Na–Mg exchange and/or the leaching of the top layer salts) have a role in the chemical composition. This demonstrates that the lake is significantly influenced by climatic variations