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 Dynamics and Changing Structure of Traditional Healing System in Nigeria

Traditional medicine had existed in Nigeria prior to the era of colonialism serving the health needs of the people. However with the advent of colonialism, it experienced restrictions and obstacles in the face of the introduction of Western medicine. In recent time, the practice got a resurgence and greater patronage by the people due to its ability to explain the ‘hidden’ cause of illness and consequently, cure the illness. This paper accounts for this renewed patronage of traditional medicine by the people by locating it in the ability of its practitioners to respond to their environment of practice. This entails a conscious restructuring and ‘modernising’ efforts at alligning its practice with current trends in orthordox practice by establishing standards of safety, efficacy and quality control. This is coupled with government recent interest in developing traditional medicine for national health system development and economic benefits.Keywords: Structure, Traditional Medicine, Colonialism, Western Medicine, Modernisin

TRADITIONAL MEDICINE PRACTICES IN NIGERIA: A SWOT ANALYSIS

The paper presents SWOT analysis of Traditional Medicine (TM) in Nigeria using various results in scientific research and author's critical opinion on the past, present and future of this important sector of agriculture. The paper is based on the study of many published articles closely connected with the topic. The results emphasized that Nigeria has a long history and culture of TM, conducive climate for the growing of herbs and other materials related to it. Also, TM is available, accessible, acceptable, affordable, widely used, and perceived as effective by the people with virtually no side effects. The weaknesses are: the unverifiable and inexplicable aspects of occultic/witchcraft practices; the practitioners lack the skill for correct diagnosis of serious disorders, inadequate coordination of practitioners activities giving room to dubious and unscrupulous elements. Also, opportunities that exists for TMP are: existence of a virile Herbs and Leaves Traditional Medicines Practitioners’ Association of Nigeria, large number of population of TM practitioners with great spread over all ethnic groups coupled with a large Nigerian population of about 170million consumers. The threats: the activities and practices of charlatans, the importation of higher quality TM products and the reality of some herbs are going into extinction. It is concluded that TM occupies a pivotal position in the Nigerian rural health service delivery system which cannot be neglected. Therefore, there is the need to create an enabling environment for the development of traditional medicine and its eventual integration into the health care delivery system of the countr

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

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

Safety and efficacy of intraperitoneal drain placement after emergency colorectal surgery. An international, prospective cohort study

Intraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery. Method: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 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 III-V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results: Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48-5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61-1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67-2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91-1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87-2.99, p = 0.128). Conclusion: This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery