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 impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Assessment of slope stability in Ankara clay: a case study along E90 highway

Some slope instability problems exist in Ankara clay along E90 highway. The purpose of this paper is to determine the mineralogical and geotechnical properties of soils, and to investigate the causes and mechanisms of three rotational landslides along a section of the highway. In order to accomplish these tasks, field studies, laboratory testing, back analyses, and limit equilibrium and finite difference analyses were performed. The landslides are formed within a soil consisting of clay and silt with a little sand and gravel. Slope stability analyses indicate that long-term stability of already failed slopes is critical. The failures are progressive, showing strain softening behavior with full saturation. Broken irrigation pipes existing near the landslides are found to be the main cause of sliding. Maintenance of the pipes, surface drainage, removal and replacement of the failed (slided) material are considered to be economical and practical solutions for the remediation of the slides

A comparative study on the actual and estimated seismic response of Kiralkizi Dam in Turkey

Kiralkizi Dam, a 120 in high earthfill dam located in Diyarbakir city, Turkey, was shaken by a moment magnitude, M-w = 4.6 earthquake at an epicentral distance of 8 km, on December 24, 2000, at 13:31 local time. The seismic response of the dam was assessed by using spectral ratios between (i) available crest and foundation records (C/F), (ii) horizontal and vertical components of the recorded motions (H/V), (iii) by performing 2 dimensional finite difference-based seismic response analyses (Flac-2D), and (iv) 1D elastic shear beam solutions. First mode of vibration of the dam in the transverse direction by all four methods were estimated in the range of 0.55 to 0.62 second. Similar close agreement was not observed in higher modal periods estimated by H/V technique as compared to the predictions by C/F, Flac-2D, shear beam analysis techniques. Thus, H/V technique was concluded to be useful for the estimation of the fundamental resonance frequency of a soil structure, but not for its higher harmonics as consistent with available limited literature. In the longitudinal direction, natural period of the dam was estimated as 0.28 and 0.82 second by H/V and C/F techniques, respectively. Such disagreement was explained by (i) differences in the definitions of the estimated periods, (ii) internal impedance contrast of the dam, (iii) contributions of 3D valley effects. Single seismometer record obtained from crest level was found to be inadequate for reliably assessing the response of a dam in the longitudinal direction, and it is recommended to install multiple seismometers both within dambody and the abutments. Last but not least, the results of these analyses were further compared by available accelograms recorded at three earthfill and rockfill dams from Japan. In general, it was concluded that the seismic response of Kiralkizi Dam is comparable and within the prediction ranges of available analyses methods and is consistent with the expected response of a dam this height