Stellar triples with chemically homogeneously evolving inner binaries

Observations suggest that massive stellar triples are common. However, their evolution is not yet fully understood. We investigate the evolution of hierarchical triples in which the stars of the inner binary experience chemically homogeneous evolution (CHE), particularly to understand the role of the tertiary star in the formation of gravitational-wave (GW) sources. We use the triple-star rapid population synthesis code tres to determine the evolution of these systems at two representative metallicities: Z = 0.005 and Z = 0.0005. About half of all triples harbouring a CHE inner binary (CHE triples) experience tertiary mass transfer (TMT) episodes, an event which is rare for classically evolving stars. In the majority of TMT episodes, the inner binary consists of two main-sequence stars (58--60 per cent) or two black holes (BHs, 24-31 per cent). Additionally, we explore the role of von Zeipel-Lidov-Kozai (ZLK) oscillations for CHE triples. ZLK oscillations can result in eccentric stellar mergers or lead to the formation of eccentric compact binaries in systems with initial outer pericentre smaller than ∼ 1200 R⊙. Approximately 24-30 per cent of CHE triples form GW sources, and in 31 per cent of these, the tertiary star plays a significant role and leads to configurations that are not predicted for isolated binaries. We conclude that the evolution of CHE binaries can be affected by a close tertiary companion, resulting in astronomical transients such as BH--BH binaries that merge via GW emission orders of magnitude faster than their isolated binary counterparts and tertiary-driven massive stellar mergers

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