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

Response of plant communities to climate change during the late Holocene: palaeoecological insights from peatlands in the Alaskan Arctic

High-resolution plant macrofossil records were examined alongside pollen, micro- and macro-charcoal, and testate amoeba data to elucidate the dynamics of two permafrost peatlands in the northern foothills of the Brooks Range, Alaskan Arctic. The vegetation dynamics of these two peatlands were driven by autogenic processes reflecting the development trajectory of the peatlands towards ombrotrophic status, and allogenic climate change. We observe an increase in shrub pollen and macrofossils (e.g. Ericaceae, Betula nana) during two Late Holocene warm episodes and in recent decades. Pollen data suggest that regional forest cover also responded to temperature increase since ca. 1950 CE. An increase of Picea pollen (up to 13%) in the upper part of peat profile is probably associated with long distance pollen transport from populations of Picea mariana and Picea glauca located at the southern foothills of the Brooks Range. Relatively small amount of micro- and macrocharcoal in the two profiles indicates little fire activity around the sampling sites over the last ca. 2000 years, which is in agreement with regional findings. The lack of surface and groundwater influence under prolonged warmer/drier condition can allow Sphagnum to expand in Arctic peatlands. Cold climatic conditions might have been detrimental to Sphagnum populations, that were replaced by Carex spp. and other vascular plants owing to wetter conditions in the peatland