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

Effects of livestock wastewater variety and disinfectants on the performance of constructed wetlands in organic matters and nitrogen removal

Background, aim and scope: Treatment performance of constructed wetlands (CWs) is largely dependent on the characteristics of the wastewater. Although livestock wastewater is readily biodegradable in general, its variety in biodegradability can still be significant in practice. In addition, it is a common practice to periodically use disinfectants in livestock activities for health concerns. Obviously, the residual of the disinfectants in livestock wastewater may have serious inhibitory effect on the microbial activities during wastewater treatment. Thus, the main objective of this study was to examine the variety of livestock wastewater in biodegradability and its effect on the performance of a pilot scale tidal flow CWs (TFCWs) in organic matter and nitrogen removal. Furthermore, investigation of the potential inhibition of the chosen disinfectants on organic matter biodegradation and nitrification was another aim of this study. Materials and methods: The TFCWs system consisted of four-stage downflow reed beds with a hydraulic loading rate of 0.29 m3/m2·per day. Long-term stored livestock wastewater and fresh livestock wastewater were used, respectively, as feed to the system in different periods. Meanwhile, batch aeration tests were carried out to investigate the difference in biodegradation of the two types of wastewaters. Inhibitions of two types of disinfectants, namely UNIPRED and HYPROCLOR ED, on microbial activities were investigated in laboratory batch tests, with dosage of from 0.05% to 0.5%. Results: With fresh livestock wastewater, removal efficiencies of up to 93% and 94% could be achieved with average of 73% and 64% for chemical oxygen demand (COD) and TN, respectively. The performance deteriorated when the system was fed with long-term stored wastewater. In the batch tests, the long-time stored wastewater was characterized as non-biodegradable or at least very slowly biodegradable, while the fresh wastewater was readily biodegradable. UNIPRED showed very strong inhibition on both heterotrophic organisms and nitrifiers. Tested inhibition started from content of 0.05%, which is 1/10 of the recommended usage rate. Inhibitory effect of HYPROCLOR ED on COD degradation started from 0.1% and complete inhibition occurred from content of 0.3%, while significant inhibition on nitrification started from 0.1%. Conclusions: Livestock wastewater could vary significantly in biodegradability and it may turn to be non-biodegradable after a long-term storage. The variety of the livestock wastewater has a decisive influence on the performance of the CWs system, especially in TN elimination. In addition, the application of disinfectants UNIPRED and HYPROCLOR ED may cause serious inhibition on microbial activities and subsequent system failure.Department of Agriculture, Fisheries and Food, Ireland: Research Stimulus Fund (project no. RSF 07-528

Risk of inflammatory bowel disease following a diagnosis of irritable bowel syndrome

<p>Abstract</p> <p>Background</p> <p>Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) symptoms often overlap. In some IBS cases there are subtle inflammatory changes similar to the immune-mediated pathophysiology of IBD, and the risk of both increases after infectious gastroenteritis (IGE).</p> <p>Methods</p> <p>To evaluate the effect of IBS and IGE on IBD risk utilizing US Department of Defense medical encounter data, active duty personnel with IBS were matched to subjects without IBS. Medical encounter history was analyzed to assess for incident IBD. IGE was identified from documented medical encounters and by self-report. Relative risks were calculated using Poisson regression models.</p> <p>Results</p> <p>We identified 9,341 incident IBS cases and 18,678 matched non-IBS subjects and found an 8.6-fold higher incidence (<it>p</it> < 0.0001) of IBD among those with IBS (238.1 per 100,000 person-years) compared to our referent population (27.8 per 100,000 person-years). In a subset (n = 2,205) of well-defined IBS cases, IBD risk was 15 times that of subjects without IBS. The median time between IBS and IBD diagnoses was 2.1 years. IGE also increased IBD risk approximately 2-fold ( <it>p</it> < 0.05) after controlling for IBS.</p> <p>Conclusions</p> <p>These data reflect a complex interaction between illness presentation and diagnosis of IBS and IBD and suggest intercurrent IGE may increase IBD risk in IBS patients. Additional studies are needed to determine whether IBS lies on the causal pathway for IBD or whether the two are on a pathophysiological spectrum of the same clinical illness. These data suggest consideration of risk reduction interventions for IGE among IBS patients at high disease risk.</p