20 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
The Effect of Sibutramine, a Serotonin-Norepinephrine Reuptake Inhibitor, on Platelets and Fibrin Networks of Male Sprague-Dawley Rats: A Descriptive Study
Sibutramine is used in the treatment of obesity due to its ability to influence feelings of hunger and satiety by
inhibiting the re-uptake of serotonin and noradrenalin in the central nervous system (CNS). Sibutramine use
has been associated with numerous adverse events in particular cardiovascular complications possibly due to
the formation of thrombi. This ultrastructural descriptive study investigated the effect of sibutramine on blood
coagulation, specifically the effect on morphology of platelets and fibrin networks using scanning electron
microscopy. Male Sprague–Dawley rats treated with either a recommended therapeutic dose [low dosage
1.32 mg/kg] or a toxicological higher dose [high dosage 13.2 mg/kg] of sibutramine for 28 days were used and
compared to control animals. Blood samples were collected and plasma smears were prepared for platelet
evaluation. Following the addition of thrombin to the plasma samples, the morphology of the fibrin clots was
evaluated. Platelet evaluation by scanning electron microscopy revealed morphology typical of a prothrombotic
state with a characteristic excessive platelet activation in both low-dose (LD) and high-dose (HD) rats. The
fibrin clots of sibutramine-treated rats, LD and HD revealed fused thick fibers with thin fibers forming a netlike
structure over the thick fibers which differ considerably from the organized structure of the control animals.
It can be concluded that sibutramine alters the ultrastructure of platelets and fibrin networks creating a
prothrombotic state.http://informahealthcare.com/journal/usp2015-12-30hb201
Flower colour variation across a hybrid zone in Antirrhinum as perceived by bumblebee pollinators
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