89 research outputs found
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
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NACA Technical Notes
"Pressure-distribution tests were made on the 32-foot whirling arm of the Daniel Guggenheim Airship Institute of a tapered wing to determine the rolling and yawing moments due to an angular velocity in yaw. The model was tested at 0 degree and 5 degrees pitch, -1 degree and 5 degree yaw, and with a full-span flap deflected 60 degrees. The results are given in the form of span load distributions and in calculated moment coefficients" (p. 1)
Recommended from our members
NACA Technical Notes
"Pressure-distribution tests were made on the 32-foot whirling arm of the Daniel Guggenheim Airship Institute of a tapered wing to determine the rolling and the yawing moments due to an angular velocity in yaw. The model was tested at 0 degree and 5 degree pitch; 0 degree, 5 degree, and 10 degree yaw; and with split flaps covering 25, 50, 75, and 100 percent of the wing span and deflected 60 degrees. The results are given in the form of load distributions and as calculated moment coefficients" (p. 1)
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