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

Research in order to decrease the time manufacturing unit using the combined tools

Abstract The work presents the results of the experimental research carried out with the purpose of increasing the productivity of the machining process in the case of a part of the automotive industry. Thus, increasing of volume the parts ordered by the beneficiary, researches have been done for the replacement of simple cutting tools (standards cutting tools) with special cutting tools (combined tools). The use of the combined cutting tools to optimize the productivity of fabrication permitted decrease operative time by reducing the time to change the tools and the machining time. The use of the combined tools allowed machining multiple surfaces. In these circumstances, it was found an improvement in both productivity and quality of the products obtained in the manufacturing process.</jats:p

Displaced creation

The ionization of atoms and molecules by strong laser fields has become a core technique in modern laser physics. Now, the electrons emerging from ionized molecules are shown to exhibit a memory of the ionization process, resulting in a spatial phase that may influence the interpretation of imaging data

STRONG-FIELD PHYSICS Ionization surprise

Faisal F. STRONG-FIELD PHYSICS Ionization surprise. NATURE PHYSICS. 2009;5(5):319-320.The common picture of how atoms and molecules are ionized in intense laser fields has had decades of success. However, the observation of an unexpected but apparently universal low-energy photoionization feature suggests this picture is incomplete