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Background: Drains are traditionally inserted during surgery for reduction of fluid accumulation in the post-operative period. The appearance of drained fluids and their quantity can be early predictors of complications. Over the years, several studies have been conducted in attempt to determine the optimal number of drains that result in low rates of fluid accumulation with minimal impairment of quality of life. Purpose: Determine the optimal number of suction drains in abdominoplasty procedures. Methods: Retrospective cohort study, analyzing all abdominoplasty patients operated by a single surgeon. Patients were stratified into 3 groups based on number of drains inserted at the end of the procedure. Rate of complications was compared between the groups and a multivariate logistic regression model was computed for the development of complications. Results: Seven-hundred and forty three patients were included in the analysis of this study. No drains were inserted in 355 patients (45%), whereas a single drain was inserted in 153 (20.6%) 2 drains in 255 patients (34.4%). Patients for whom a single drain was inserted intra-operatively, experienced at a statistically significant lower rate, surgical site infections (OR = 0.235), hypertrophic scars (OR = 0.326), wound dehiscence (OR = 0.272), as compared to patients with no drains. On the contrary, insertion of single drain was associated with a statistically significant higher risk for development of seroma (OR = 6.276) and the need for revision surgery (OR = 2.452). Conclusion: Insertion of a single drain is associated with a lower risk of SSI and wound- dehiscence, but a greater risk for seroma development that requires surgical intervention. Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Introduction: Intra‐abdominal drains are often placed in emergency gastrointestinal surgery procedures with the aim to prevent the formation of intra‐abdominal collections (IAC) and aid in their early detection. However, the evidence for this is debated. This scoping review aims to evaluate the current evidence for their use in this setting. Methods: A literature search was performed using MEDLINE via PubMed, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov. Primary studies published between January 2000 and September 2023 that assessed intra‐abdominal drain placement and post‐operative IAC formation in emergency gastrointestinal surgery were included. Results: A total of 26 articles were identified. There was no strong evidence to suggest that prophylactic intra‐abdominal drain placement influences the formation of IAC in emergency gastrointestinal procedures. There was a suggestion that drain placement may increase the rate of surgical site infection and length of hospital stay. However, current studies on the topic are of poor quality and high risk of bias. Conclusion: The undifferentiated use of drains in emergency gastrointestinal surgery should not be encouraged. Drain placement should be specific to the clinical context. Higher quality research is warranted to better understand the influence drain placement has on post‐operative outcomes. [ABSTRACT FROM AUTHOR]

Patients submitted to heart surgery are restricted to the bed of the Intensive Care Units (ICUs), due to this period of immobility the individual is likely to present clinical and functional alterations. These complications can be avoided by early mobilization; however, in some hospitals, this is not feasible due to the use of subxiphoid drain in the immediate postoperative period. To verify the safety and feasibility of mobilizing patients after cardiac surgery using subxiphoid drain. This was a prospective cohort study. On the first day the patient was positioned in sedestration in bed, then transferred from sitting to orthostasis, gait training and sedestration in an armchair. On the second postoperative day the same activities were performed, but with walking through the ICU with a progressive increase in distance. At all these moments, the patient was using the subxiphoid and intercostal drain. The patients were seen three times a day, but physical rehabilitation was performed twice. The adverse events considered were drain obstruction, accidental removal or displacement, total atrioventricular block, postoperative low output syndrome, cardiorespiratory arrest, pneumomediastinum, infection, and pericardial or myocardial damage. 176 patients were evaluated. Only 2 (0.4 %) of the patients had complications during or after mobilization, 1 (0.2 %) due to drain obstruction and 1 (0.2 %) due to accidental removal or displacement. Based on the data observed in the results, we found that the application of early mobilization in patients using subxiphoid drain after cardiac surgery is a safe and feasible conduct. [ABSTRACT FROM AUTHOR]

Study region: Artificially drained agricultural land in northwest Europe. Study focus: The use of application timing as a mitigation tool for pesticide leaching to drains was investigated by simulating pesticide fate after application every day in a pesticide-specific application window, using the agro-hydrological model DAISY. The simulations were carried out for six combinations of pesticide-crop-seasons using three synthetically generated climate series and 800 soil profiles. The simulated drain concentrations were transformed to normalized pesticide concentrations in a hypothetical adjacent stream. Each application day was then characterized by the maximum normalized hourly pesticide concentration in the stream, expressed as the maximum hourly toxic unit (mTU), occurring within 300 days after application. New hydrological insights for the region: The result showed that if the pesticide was applied consistently every year at the best application day, pesticide leaching, in terms of the 90th percentile of mTU, could be reduced by up to 62% compared to a random application. If the pesticide application day was restricted to vary in a five-day period, the 90th percentile of mTU could be reduced by up to 21%. Thus, our study shows that there is a significant mitigation potential for reducing pesticide leaching to drains by tailoring the timing of pesticide application to weather conditions.

Purpose: The usefulness of closed suction drains (CSD) after open reduction and internal fixation (ORIF) of tibial plateau fractures is a contested topic. The purpose of this study was to examine the impact of CSD in postoperative outcomes after tibial plateau fracture. Methods: Data were retrospectively collected from patients who underwent primary repair of closed tibial plateau fractures via an anterolateral approach between June 2021 to May 2022 at a single academic center. Fifty-six patients were included and 28 received CSDs at time of surgery. P values less than 0.05 were considered significant. Results: Fifty-six patients were included. There was no significant difference in demographics, pre- and post-op hemoglobin, estimated blood loss during surgery, length of stay, postoperative MMEs and pain at 3 month follow-up, deep vein thrombosis (DVT), compartment syndrome, flexion contracture, use of incisional vac, infection rate, wound drainage, hematoma, neurologic pain, dehiscence, additional surgery, or range of motion at 3 months follow-up. We noted a significant difference in Defense and Veterans Pain Rating Scale (DVPRS) on POD1, demonstrating greater pain in those in the CSD group. Conclusion: Our findings suggest that the use of CSD in ORIF of tibial plateau fractures may not be of significant prophylactic benefit. CSDs in ORIF patients were associated with increased early postoperative pain and had no identifiable benefits. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Population expansion within agricultural lands applies pressure on natural resources, particularly water resources, and leads to contamination through different types of pollutants, such as heavy metals, that consequently alter the ecosystem and impact human health. In the present work, several heavy metals in sediment along the Kitchener drain were assessed using different soil quality and health indices; the Kitchener drain is one of the major drains in the Nile Delta. Sediments were collected from six stations along the drain from upstream to downstream. Soil physical and chemical properties were analyzed as well as four metal pollution indices and five ecological risk indices. Additionally, carcinogenic and noncarcinogenic risks for adults and children were evaluated. The data showed that the Kitchener drain is mainly contaminated with Cd, Pb, and Zn, where the concentrations decreased from upstream to downstream. The eco-toxicological indexes showed that Pb, Zn, and Cr were the most hazardous metals along the drain, mainly at upstream stations. The human health risk indices data revealed that the noncarcinogenic risk of the studied metals can be ordered as follows: Co > Cr > Pb > Mn > Ni > Cd > Cu > Zn for adults, while for children it was Cr > Mn > Co > Pb > Ni > Cd > Cu > Zn. The carcinogenic risk data showed that heavy metals ranged from low to medium in all sites, except for Pb and Zn, which have high carcinogenic risks. The present study showed more contamination upstream compared to downstream which can be attributed to urbanization and human activity, as shown from the land use/landcover map. This highlighted that the major drains inside the Nile Delta suffer from different anthropogenic activities that should be taken into consideration by researchers, scientists, and policymakers. Also, the source of heavy metal pollution, particularly upstream, should be controlled or treated before discharge into the drain. On the other side, downstream (toward the Mediterranean Sea), the heavy metals could affect the trophic levels of the marine ecosystem on the Mediterranean Sea which should be taken into consideration. [ABSTRACT FROM AUTHOR]

Aim: In cases such as colostomies, enterocutaneous fistulas and catheters leaking fluid from the environment; the use of stoma bags is necessary. The aim of this study; it is to present the invention called "stoma bag cover" that can be used instead of laborious applications such as opening the stoma bag completely to make an enema or puncturing the bag for drainage. Material and Methods: Stoma bag cover is a cover that can be placed in the anterior middle part of the stoma bags and provides an opening through which catheters can come out. In addition, in order to prevent leakage around the drain, there is a nylon structure prepared with a purse-shaped thread around the inside of the cover. By knotting this nylon structure after the drain or catheter is passed through the thread at the end, the space that will cause leakage around the drain is eliminated. In addition, if the need for the opening in the stoma bag ends, the cover is designed to be closed and leakproof. Results: Stoma bag cover; it provides a more practical and effective mechanism for applications that are sometimes insufficient to prevent leakage, such as tying and taping applied to drains removed from the stoma bag. In addition, this invention is a valve mechanism that can enable some necessary applications without opening the stoma bag completely without contamination. Conclusion: It is expected that this invention will provide healthier results and comfort compared to previous applications, both by providing ease of application and reducing contamination. [ABSTRACT FROM AUTHOR]

Reducing postoperative strain on the patient after rhinoplasty is an important goal for the surgeon. Many strategies are described to reach that goal. One strategy is to remove blood from under the dissected soft tissue envelope by drains, before it can infiltrate the different layers causing ecchymosis, edema, and swelling. In our setting with wide degloving and using drains, we could show a significant reduction in ecchymosis on day 2 and 14 after surgery (p = 0.006 and p = 0.017). We also observed a significant effect for edema and general swelling on day 2 (p = 0.027 and p = 0.004), but this effect did not reach significance for these two parameters on day 14. And although the long-term effect needs to be assessed in the future, we found that using drains in open rhinoplasty with wide degloving is an easily applicable, cheap, and reproducible approach to reduce postoperative ecchymosis, edema, and swelling. [ABSTRACT FROM AUTHOR]

In recent decades, Lake Qarun significantly suffered from the adverse effects of climate change (e.g., high evaporation rate) and human activities (e.g., industrial and agricultural development within the catchment). The objectives of this work were to (i) evaluate the sediment characteristics due to the impact of the catchment on the lake and (ii) estimate the sedimentation rates and relate these to historical changes in sediment. Three sediment Cores collected in 2018 from Lake Qarun were sliced into 5 cm intervals, and the radionuclides 210Pb and 137Cs were measured using a γ spectrometer. The best validated models were the constant rate of supply (CRS) and the correct CRS(C-CRS). The results provide evidence that grain size, sediment fractions, organic matter (OM), organic carbon (OC) and sedimentation rate are all significantly influenced by agricultural and industrial activities.The geochronology models of 210Pb indicated changes in the sedimentation process of Lake Qarun for 100 years that could be a vital source of information regarding changes in the regional and global hydrology. The estimated mean sedimentation rate based on the 210Pb model is 0.45 ± 0.1 cm yr−1 that extremely close to the sedimentation rate of the 137Cs marker is 0.55 cm yr−1 that indicates an excellent agreement in terms of sedimentation rate. [ABSTRACT FROM AUTHOR]

This paper reports the results of dynamic centrifuge tests carried out on sandy models alternatively equipped with vertical or horizontal drains. The main aim of the experimentation was to investigate the use of horizontal drains to mitigate the liquefaction susceptibility of sandy deposits and to validate their applicability as a remediation technique applicable in urban and industrial areas to protect existing buildings from liquefaction. The assessment and validation were carried out by comparing the seismic behavior of models treated with horizontal drains with that of the untreated model and models equipped with vertical drains. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain the use of draining the thyroid bed following surgery. Methods: Fifty four patients who underwent total thyroidectomy were enrolled in the study between March 2021 and July 2022 and randomly allocated into 2 groups -- a drain group and a no drain group. The hospital stay, operating time, post operative pain, post operative complications, cosmesis, and patient's perspectives were compared. Results: The mean duration of hospitalization was significantly shorter in the no drain group as compared to the drain group. The post operative pain, as assessed by the Mankoski Pain Scale (MPS) was significantly higher in the drain group than in the no drain group. The cosmetic evaluation undertaken using the Hollander Wound Evaluation Scale, noted that there was a statistically significant difference in scarring between the 2 groups. There was no statistically significant difference in the duration of surgery and post operative complications between the two groups. Patient satisfaction was also noted to be superlative in the no drain group. Conclusion: The routine drain placement following thyroidectomy places the patient at a disadvantage in terms of longer hospitalisation, increased post operative pain and poor cosmetic outcome. [ABSTRACT FROM AUTHOR]

This retrospective study examined the presence of carbapenemase-producing Enterobacteriaceae in hospital water environments. Results showed that carbapenemase-producing Enterobacteriaceae was detected in 41.5% of the samples within 1 m of a water source (showers or sinks), with 20.6% of the positive samples associated with shower water sources. • A high prevalence of carbapenemase-producing Enterobacteriaceae (CPE) within 1 m of a water source was found (41.5%). • Approximately one-fifth of positive samples were linked to showers, highlighting the need to consider them as potential sources of CPE transmission. • Near water samples were highly positive in nonclinical areas like storage rooms and staff rooms, emphasizing the importance of strict infection control measures in these areas. [ABSTRACT FROM AUTHOR]

Introduction: The use of drains in orthopedic practice has been affected by the concept of evidence-based medicine, which is accepted as the standard of care for all surgical or medical practices. This concept questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi-center meta-analytical studies that have found drains to be of little or no benefit in trauma and orthopedic surgeries. As a result of these studies, there are few situations where drains are routinely used, such as calcaneal fractures in developed countries. Even major procedures such as total knee and arthroplasties are being performed without drains. We aim to investigate whether similar evidence can be found in our practice. Materials and Methods: This sounds like the description of a prospective randomized controlled trial studying the use of drains in certain types of surgical procedures. The study population consisted of 86 patients matched for sex and type of injury, and they were assigned to either a group that used drains or a group that did not use drains during their operations. The study aimed to observe and compare the rates of complications, such as hematoma, drain migration, infection, and inadvertent drain stitching, between the two groups. Results: Eighty-six major orthopedic operations were studied. There was no evidence of the occurrence of complication arising from nonuse of drains in the undrained group. Those patients whose wounds were drained had no need for drain change, thus making the wound care less eventful. Conclusion: Wound drains can help reduce tissue swelling in the postoperative period, but there is no significant difference in infection rates, hematoma, or seroma formation between drained and undrained wounds.

Background: Despite multiple studies and randomized trials, there remains controversy over whether drains should be placed, and if so for how long, after pancreas resection. The aim was to determine if post-pancreatectomy drain placement and timing of drain removal were associated with differences in infectious outcomes and, if so, which specific procedures and infectious sites were most at risk. Methods: The ACS-NSQIP targeted pancreatectomy database was utilized to identify patients who underwent pancreatectomies between 2015 and 2020 with postoperative drain placement for retrospective cohort analysis. A propensity score matching analyses was conducted to determine associations between drain placement and surgical site infections (SSI). Results: Of 39,057 pancreatic resections, 66.4% were proximal pancreatectomies, and 33.6% were distal pancreatectomies. After propensity score matching, drain placement was not associated with significantly lower rates of superficial SSI (7% vs 9%, p = 0.755) or organ/space SSI (17% vs 16%, p = 0.647) after proximal pancreatectomy. After distal pancreatectomy, drain placement was associated with higher rates of organ/space SSI (12% vs 9%, p = 0.010). Drain removal on or after postoperative day 3 was significantly associated with higher rates of SSI in both proximal and distal pancreatectomy. Conclusions: Drain placement is associated with an increased rate of organ/space SSI after distal pancreatectomy and not after pancreaticoduodenectomy. When drains are utilized, early removal is associated with a reduction of SSI after all types of pancreatectomy. In surgical units where post-pancreatectomy SSI is a concern, selective drain placement for high-risk glands or after distal pancreatectomy, combined with early drain removal, may be considered. [ABSTRACT FROM AUTHOR]

Background: One of the most frequent surgeries a general surgeon performs is thyroid surgery. Nearly all surgeons utilize a closed vacuum drain at the conclusion of the intervention in an effort to avoid the deadliest complication, a smothering hemorrhage, which several studies suggest may not be essential. Thus, it may be necessary to evaluate the benefit of drainless following thyroidectomy by looking at factors like length of hospital stay, post-operative pain, and wound sepsis. Objective: The aim of the current study was to evaluate the advantages of drain-free surgery following thyroidectomy, postoperative pain, wound sepsis, seroma formation and hematoma. Patients and methods: A randomized controlled clinical trial was conducted at the General Surgery Department, Zagazig University Hospital in Sharkia, Egypt. A total of 30 enlarged thyroid patients were included in the study; 15 patients underwent a thyroidectomy without drain (Group A) and 15 patients underwent thyroidectomy with a drain (Group B). Results: Regarding post-operative complications including hematoma, infection, dehiscence, and seroma, there was no statistically significant difference between the studied groups. Group B had a higher infection rate. Group A had a longer postoperative hospital stay and a higher postoperative pain score (VAS), with statistical significant differences. Conclusion: Without drains, thyroidectomy is possible, less uncomfortable, results in an earlier discharge and hence lower costs, and doesn't raise the risk of postoperative complications. [ABSTRACT FROM AUTHOR]

The exposure variation of arsenic from different ground and surface water sources has remained unpredictable which may cause severe human health problems. The current study is, therefore, designed to analyze the spatial variability of arsenic contamination in shallow aquifer and assess the potential human health risks. For this purpose, a total of 55 groundwater, 10 drain water, 4 river water, and 6 sediment samples were collected along zero to 5 km stretch of the River Ravi, Lahore. All water samples were tested for As, pH, and total dissolved solids (TDS), whereas sediments were only tested for As. Health risk models were used to predict cancer and non-cancer risk in adults and children. Among water samples, highest median (minimum–maximum) concentrations (µg/L) of As were recorded 53.32 (1.98–1555) in groundwater, followed by 53.04 (1.58–351.5) in drain water, and 4.80 (2.13–8.67) in river water, respectively, whereas As concentration (mg/kg) in river sediments was 6.03 (5.56–13.92). Variation of As in groundwater was non-significant (P > 0.05) among every 1-km stretch from the Ravi River. However, maximum median concentrations (µg/L) of 60.18 and 60.08 were recorded between 2–3 and 0–1 km from River Ravi, respectively, reflecting possible mixing of river water with shallow aquifers. A very high cancer and non-cancer risk (HI > 1.0 × 10−4) through groundwater As exposure was predicted for both children and adults. The current study concluded that prevalence of As above WHO prescribed limits in shallow aquifer along the urban stretch of the River Ravi is posing serious health risk to the exposed population. [ABSTRACT FROM AUTHOR]

Background: Subdural drains are used to reduce recurrence after surgical evacuation of chronic subdural hematoma. There is a small risk of parenchymal injury. We hypothesize that using subgaleal drains with low active suction (-50 mm Hg to -100 mm Hg) may be a safer alternative and still maintain efficacy in preventing recurrence., Methods: A retrospective review of adult patients who underwent surgical drainage of chronic subdural hematoma at our institution was performed. They were classified into 2 groups: a subdural group and a subgaleal group. We collected data on patient demographics, preoperative use of antiplatelets or anticoagulants, the type of drains used, laterality of burr-hole surgery performed and postoperative complications, and recurrence. Descriptive statistics and regression analyses were used to analyze the data., Results: 322 patients recruited, 172 received subgaleal drains with low active suction and 150 received passive subdural drains. There was no significant difference in the rate of recurrence; there was 11. % recurrence in the subgaleal drain group and 9.3% recurrence in the subdural drain group (P = 0.660). Patients who underwent active subgaleal drain insertion had significantly fewer complications, at 2.3% compared with 8.0% in patients who had passive subdural drains (P = 0.037)., Conclusions: The use of subgaleal drains with low active suction led to significantly lower complication rates compared with the use of subdural drains and maintained its efficacy in preventing recurrence., (Published by Elsevier Inc.)

Background: Symptomatic postoperative spinal epidural hematomas (PEDHs) are rare complications, with significant implications on patients' functional outcomes. Strategies for PEDH prevention are poorly understood. This study sought to evaluate preoperative and intraoperative variables predicting the risk of PEDH and patients' functional outcomes after PEDH evacuation., Methods: This is a single institution study of all patients with PEDH requiring reoperation and matched controls over a 6-year period. The incidence of PEDH was calculated by region and operative technique. The preoperative and intraoperative parameters of 40 patients and 40 matched controls were compared., Results: A total of 5941 spine surgeries and 40 patients with symptomatic PEDH requiring reoperation were identified (0.67% overall incidence). The highest incidence of PEDH was observed after minimally invasive lumbar laminectomies. Higher preoperative diastolic blood pressure was a risk factor for PEDH. Of the 17 PEDH patients in whom a drain was placed at the time of index surgery, 8 patients (47%) still had the drain in place at the time of diagnosis of PEDH. Among the posterior index approaches, 18 patients (51.43%) (1 cervicothoracic and 17 lumbar) did not develop paresis at the time of PEDH diagnosis. Seventeen patients (48.57%) (9 cervicothoracic and 8 lumbar) developed paresis. Ten of the patients with paresis had complete resolution of motor weakness, whereas 7 never achieved complete resolution., Conclusions: Although the incidence of PEDH was less than 1%, nearly half of the patients developed motor weakness as a presenting symptom and a third of the patients never had resolution of the weakness., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The present study was conducted to investigate the potential of the free-floating macrophytes Pistia stratiotes to remediate nutrients and restore the eutrophic drain (Al-Sero Drain), South Nile Delta, Egypt. Plant and water samples were collected monthly for ten months using three randomly distributed quadrats in each of three sites. Monthly significant variation in all investigated water nutrients was recorded. The plant biomass showed bell-shaped distribution, with the lowest shoot and root biomass during May, while their peaks were during September. The plant shoots accumulated higher concentrations of most nutrient elements, except Mg, than the roots. The order of nutrients concentration (%) in P. stratiotes shoot was K > N > Ca > Na > Mg > P, while in the root was K > N > Na > Ca > Mg > P. Most nutrients standing stock (g/m−2) had the same biomass trend with the minimum during May and the maximum during August–October, which is the potential period for mowing the plant to remediate the highest nutrients and restore the eutrophic watercourses. Most investigated nutrients (except Ca) content in water were significantly correlated to their concentration in the different plant organs, which in turn provide a quantitative assessment of the environmental quality that suggests the potential use of this plant as a biomonitor of nutrient elements in eutrophic watercourses.

Population expansion within agricultural lands applies pressure on natural resources, particularly water resources, and leads to contamination through different types of pollutants, such as heavy metals, that consequently alter the ecosystem and impact human health. In the present work, several heavy metals in sediment along the Kitchener drain were assessed using different soil quality and health indices; the Kitchener drain is one of the major drains in the Nile Delta. Sediments were collected from six stations along the drain from upstream to downstream. Soil physical and chemical properties were analyzed as well as four metal pollution indices and five ecological risk indices. Additionally, carcinogenic and noncarcinogenic risks for adults and children were evaluated. The data showed that the Kitchener drain is mainly contaminated with Cd, Pb, and Zn, where the concentrations decreased from upstream to downstream. The eco-toxicological indexes showed that Pb, Zn, and Cr were the most hazardous metals along the drain, mainly at upstream stations. The human health risk indices data revealed that the noncarcinogenic risk of the studied metals can be ordered as follows: Co > Cr > Pb > Mn > Ni > Cd > Cu > Zn for adults, while for children it was Cr > Mn > Co > Pb > Ni > Cd > Cu > Zn. The carcinogenic risk data showed that heavy metals ranged from low to medium in all sites, except for Pb and Zn, which have high carcinogenic risks. The present study showed more contamination upstream compared to downstream which can be attributed to urbanization and human activity, as shown from the land use/landcover map. This highlighted that the major drains inside the Nile Delta suffer from different anthropogenic activities that should be taken into consideration by researchers, scientists, and policymakers. Also, the source of heavy metal pollution, particularly upstream, should be controlled or treated before discharge into the drain. On the other side, downstream (toward the Mediterranean Sea), the heavy metals could affect the trophic levels of the marine ecosystem on the Mediterranean Sea which should be taken into consideration.

Background: Wound suction drains have been used to decrease the rate of postoperative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. Although the use of surgical drains dates back to the years of Hippocrates, in the orthopedic literature these drains have not been shown to be beneficial in decreasing the rates of these complications, especially in orthopedic procedures including fracture fixation or arthroplasty surgeries. However, these drains are still commonly used throughout the orthopedic community, including spine surgery. Aim of the Work: This study aims to review the use of closed suction drains in spine surgery. It aims to perform a systematic review and meta-analysis of the outcome of use of drains, their method and provide intervention recommendation by the best available evidence. Material and Methods: We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. We used the following search strategy for searching different databases. "Wound drain" OR "Suction drainage" OR "Drain" OR "Spine Surgery" OR "Spine" OR "SSI" OR "Surgical Site Infection" OR "Hematoma") AND ("Vertebral Column" OR "Column, Vertebral" OR "Columns, Vertebral" OR "Vertebral Columns" OR "Spinal Column" OR "Column, Spinal" OR "Columns, Spinal" OR "Spinal Columns" OR Vertebra OR Vertebrae). All the references of the included studies were searched for relevant studies. Results: In contrast to other spine procedures, posterior spinal fusion as a surgical treatment for adolescent idiopathic scoliosis necessitates big skin incisions, a lengthy operating duration, and a higher rate of blood transfusion. This meta-analysis comprised four studies. Surprisingly, drains had no effect on total blood loss, the rate of post-surgical infection, the rate of post-operation hematoma, or hospital stay. The drain group required greater blood transfusion than the non-drain group, according to. A drain could also result in a post-durotomy fistula. Drain use is not required after intra-dural spinal cord tumor surgery. Regarding the difference in hemoglobin between preoperative and day 3 postoperative 3 studies, no difference was found between the drain group and the no drain group in all spine surgeries. Conclusion: The routine use of a drain in post-operative spine surgery appears to have no effect on the likelihood of post-operative surgical site infections or post-operative epidural hematoma, according to this study. It does, however, increase total estimated blood loss without lowering hemoglobin levels, and has no effect on hospital stay length. To further strengthen any meta- analysis in the future, high-quality studies addressing their use in the spine are require. Key words: Drains, Spine Surgery. [ABSTRACT FROM AUTHOR]

Background: Drain practices in minimally invasive retromuscular ventral hernia repairs have largely been transferred over from open surgery without significant review. We wished to evaluate the role of drains in these repairs.Methods: Using the Abdominal Wall Reconstruction Surgical Collaborative (AWRSC) registry, patients with ventral hernias who underwent enhanced-view totally extraperitoneal (eTEP) repairs between February 2016 and September 2019 were evaluated. Patients with contamination or active infection within the surgical field, those who underwent an emergent or hybrid repair, or received a concomitant procedure were excluded. Propensity score matching based on the defect size, previous hernia repair status, and the use of posterior component separation (PCS) was used to match patients with drains to patients without drains. We evaluated 180-day outcomes in terms of SSIs, SSOs, and recurrence.Results: 308 patients met the inclusion criteria. After propensity score matching, 48 patients with drains and 72 without drains were included in the analysis cohort. Those with drains were older with a greater likelihood of an incisional hernia, but were broadly similar for other relevant demographic and hernia-related variables. While there was no difference in the incidence of SSOs and SSIs between the two groups, we report a higher risk of SSOs needing procedural intervention (SSOPI) and recurrence, with a lengthened hospital stay in the cohort that received surgical drains.Conclusion: The use of surgical drains in "clean" eTEP repairs of ventral hernias appears to be common, with a selection bias for more complex cases. Based on our analysis, we found the use of drains was associated with longer hospital stays. The use of drains did not change the likelihood of suffering an SSI or SSO. However, the incidence of SSOPIs was higher despite the use of drains, which raises questions about their protective role in these repairs. [ABSTRACT FROM AUTHOR]

While drains have been routinely used in orthopaedic surgery for postoperative wound drainage following inpatient surgical procedures, there are no published reports on the efficacy of drains for outpatient orthopaedic surgeries. This review reports our experience between July 2021 and January 2022 with the use of drains for 35 patients having outpatient orthopaedic surgery. Consequences of drain usage were determined by medical chart review and a follow-up telephone survey in which patients were asked a series of questions regarding the drains used for their operation. None of the patients had an infection or any other medical problem as a result of drain usage and there were no problems with wound healing. Patients were quite capable of managing and removing their own drains. We conclude that drains are effective and can be used safely for outpatient orthopaedic surgical procedures. [ABSTRACT FROM AUTHOR]

This paper reports the results of dynamic centrifuge tests carried out on sandy models alternatively equipped with vertical or horizontal drains. The main aim of the experimentation was to investigate the use of horizontal drains to mitigate the liquefaction susceptibility of sandy deposits and to validate their applicability as a remediation technique applicable in urban and industrial areas to protect existing buildings from liquefaction. The assessment and validation were carried out by comparing the seismic behavior of models treated with horizontal drains with that of the untreated model and models equipped with vertical drains.

Objective: To determine the effectiveness of drainless thyroidectomy in terms of postoperative bleeding. Material & Methods: This randomized controlled trial was conducted in Khyber Teaching Hospital on 40 patients from January 2019 to December 2019 after getting ethical approval from the hospital ethical committee. Two groups were allocated consisting of 20 patients, one with drainage and one without drainage, and were observed for bleeding during their stay in the hospital postoperatively. Data was collected using SPSS-21 to compare the effectiveness of both the procedures and the results were described in the form of tables. Results: The difference in complication rates was not significant in the two groups. In the drainless group, two cases of seroma (5%) were noted in both groups. One case of hematoma was observed in the drain group. No case of hematoma was reported in the drainless group. Conclusion: The use of drainless thyroidectomy can be justified based on the available data in this study where no bleeding was observed in the intervention group. [ABSTRACT FROM AUTHOR]

Background: Closed wound drainage has been extensively studied in the hip and knee arthroplasty literature with equivocal results on its clinical benefits. Although also used in orthopaedic surgeries like ankle arthrodesis and ankle arthroplasty, large-scale data are currently lacking on utilization patterns and real-world effectiveness. We, therefore, aimed to address this research gap in this distinct surgical cohort using national claims data. Methods: Using the Premier Healthcare claims database from 2006 to 2016, ankle arthrodesis (n=10,085) and ankle arthroplasty (n=4,977) procedures were included. The main effect was drain use, defined by detailed billing descriptions. Outcomes included blood transfusion, 90-day readmission, and length and cost of hospitalization. Mixed-effects models measured associations between drain use and outcomes. Odds ratios (OR, or % change), 95% CIs, and P values are reported. Results: Overall, drains were used in 11% (n=1,074) and 15% (n=755) of ankle arthrodesis and ankle arthroplasty procedures, respectively. Drain use dramatically decreased over the years in both surgery types: from 14% to 6% and 24% to 7% between 2006 and 2016, for arthrodesis and ankle arthroplasty procedures, respectively. After adjustment for relevant covariates, drain use was associated with increased odds of blood transfusion in ankle arthrodesis surgery (OR 1.4, CI 1.1-1.8, P =.0168), whereas differences that were statistically but not clinically significant were seen in cost and length of stay. In total ankle arthroplasty, no statistically significant associations were observed between drain use and the selected outcomes. Conclusion: This is the first national study on drain use in ankle surgery. We found a decrease in use over time. Drain use was associated with higher odds of blood transfusion in ankle arthrodesis patients. Although this negative effect may be mitigated by the rapidly decreasing use of drains, future studies are needed to discern drivers of drain use in this distinct surgical population. Level of Evidence: Level III, retrospective cohort study [ABSTRACT FROM AUTHOR]

Six heavy metals (Fe, Cd, Co, Cr, Ni, and Pb) were measured in all 15 sediment samples collected from three drains south of Manzala Lake (Egypt). The possible environmental risks of heavy metals in the sediment of the three drains were investigated using soil indices and risk assessment. Results showed that heavy metal contamination was found at the studied sites along the three drains, and pollution levels varied depending on metals and sites. The mean concentration (mgkg-1) ranked in the order of Fe (3950) > Cd (22.36) > Cr (21.15) > Co (19.01) > Pb (14.16) > Ni (10.40) for Faraskour drain, Fe (5068) > Cd (30.29) > Co (18.97) > Cr (16.90) > Ni (15.03) > Pb (12.16) for Al-Etaiwy drain and Fe (56.12) > Cd (19.60) > Co (17.15) > Ni (14.88) > Cr (10.10) > Pb (10.03) for Ramsis drain. The mean ranges of enrichment factor for Cd, Co, Pb, Ni and Cr were 167.5-3858, 6.11-51.78, 4.38-31.20, 1.07-11.84 and 0.61-7.43, respectively. The average degree of contamination revealed that the majority of the sites had reached very high levels of pollution, with the exception of site 1, which had reached a moderate level of contamination. The ecological risk of heavy metals can be ranked as follows: Cd > Co > Pb > Ni > Cr, and the potential ecological risk index (PERI) were 931.0, 1173 and 818.5 in the Faraskour, Al-Etaiwy and Ramsis drains, respectively. To decrease pollution in these drains, it was determined that more effective restrictions on Cd and Co were needed. In general, the mean levels of Cr, Ni, and Pb in sediments from the three drains are within the European Union (EU) and Canadian Soil Quality Guidelines (CSQGD), Cd higher than EU and CSQGD, and Co higher than EU but lower than CSQGD. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) after thoracolumbar osteosynthesis is a common complication. Its management relies on surgical revision and antibiotic therapy, but treatment failure is not uncommon. The aim of our study was to assess the frequency of SSI management failure and its risk factors. Methods: A retrospective study of patients hospitalized from 2011 to 2019 at the University Hospital of Caen was carried out. The infection rate and the time to onset of failure were assessed over a minimum follow-up of 1 year. Treatment failure was defined as the occurrence of a new intervention in the spine in the year following the end of antibiotic therapy, the establishment of long-term suppressive antibiotic therapy, or death from any cause within 1 year of the end of antibiotic therapy. We compared the treatment failure group with the treatment success group to determine risk factors for treatment failure. Results: A total of 2881 patients underwent surgery during the study period, and 92 developed an SSI, corresponding to an SSI rate of 3.19%. Thirty-six percent of the patients with an SSI presented treatment failure. The median time to failure was 31 days. On multivariate analysis, diabetes mellitus was identified as a risk factor for treatment failure, whereas prolonged postoperative drainage for 4 to 5 days was a protective factor. Conclusions: The number of failures was significant, and failure occurred mainly during the early phase. To decrease the risk of treatment failure, prolonged duration of postoperative drainage seems to be helpful. Additionally, as diabetes is a risk factor for treatment failure, good control of glycemia in these patients might impact their outcomes. [ABSTRACT FROM AUTHOR]

Despite the liver being one of the most frequently injured abdominal organs in trauma patients, clinical management strategies differ between trauma surgeons. Few studies have critically evaluated current practice patterns in the operative management of liver trauma. Historical studies recommended against the use of drains but there has not been a modern investigation of this issue. The objective of this study was to analyze outcomes associated with intra-operative drain use for liver trauma. A retrospective chart review of all adult trauma patients presenting to a Level I trauma center from 2012 to 2018 was performed. Patients who underwent operative management of liver trauma were divided into groups based on whether an intra-abdominal drain was utilized and differences in outcomes between the groups were analyzed. The primary endpoint evaluated was post-operative intra-abdominal abscesses. Univariate and multivariate analyses were performed. 184 patients with operative management of liver trauma were included in the study. Closed suction drains were utilized in 26.1% of post-operative patients. Rate of intra-abdominal abscesses was significantly higher in the drain group (35.4% versus 8.8%, P < 0.001). Drains were more commonly used in patients receiving more units of PRBCs (median, 9 units [IQR 4-20] versus median 5.5 units, [IQR 2-14], P = 0.03). Drain use was found to be an independent risk factor for post-operative intra-abdominal abscess on multivariate analysis (OR 4.9, 95% CI 1.7-14, P = 0.003). The results of this study support previous conclusions that drain placement for operative liver trauma is associated with increased risks of infectious complications. Drains were used in patients with more severe liver injury, intra-operative bile leaks, penetrating trauma, and increased blood transfusion requirements. Future studies should focus on the development of specific guidelines for the use of drains in liver trauma. [ABSTRACT FROM AUTHOR]

Introduction: Incisional hernia is one of the common complications following abdominal surgery in patients undergoing laparotomy. Various surgical procedures are performed by creating a potential space and placing a foreign body (mesh), which may render the wound susceptible for many postoperative complications. It is clinically important to evaluate the efficacy of Incisional Negative Pressure Wound Therapy (INPWT) in reducing wound complications. Aim: To compare the efficacy of INPWT dressing with traditional gauze dressing in reducing postoperative complications following meshplasty in incisional hernia repair. Materials and Methods: This was a hospital-based randomised controlled trial, conducted in the Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, from October 2013 to July 2015. 64 consenting patients with incisional hernias undergoing meshplasty were included in this study. After being randomised into the two study groups, they had their postoperative wounds dressed with either INPWT (Group A) for five days, or traditional gauze (Group B) based dressings. Operative parameters like duration of surgery, type of dissection and type of skin sutures used were studied and analysed. Also, postoperative outcomes like Surgical Site Infection (SSI), seroma, duration of drain, hospital stay were analysed using Chi-square or Fisher's-exact test. Results: Out of total 64 patients, there was a statistically significant reduction in the volume of drain (p=0.004) and duration of wound drainage (p=0.029) with the use of INPWT. There was also a reduction in the incidence of SSI (6.7% vs 17.6%) and seroma (6.7% vs 11.8%) and the duration of postoperative hospital stay (6.03±1.99 days vs 7.09±2.31 days) in the INPWT group, which were however not statistically significant. Age, comorbidities, Body Mass Index (BMI), duration of surgery, type of dissection and type of skin sutures were not found to have any effect on the parameters assessed. Conclusion: Incisional negative pressure wound therapy in postoperative wounds, following meshplasty for incisional hernia significantly reduces the volume and duration of wound drainage. It also reduces the incidence of SSI, seroma and the duration of hospital stay. [ABSTRACT FROM AUTHOR]

Background  Surgical drains are routinely used following autologous reconstruction, but are often cited as the leading cause of peri-operative discomfort. This study defined routine drain use duration and assessed the risk factors for prolonged breast and abdominal drain use during microvascular breast reconstruction, measures which have never previously been defined. Methods  Patients who underwent an abdominal microvascular free flap were included. Demographics, comorbidities, and operation-related characteristics were retrospectively collected in a prospectively maintained database. Statistical analysis utilized chi-square independent t -test, and linear regression analyses. Results  One hundred forty-nine patients comprising 233 breast flaps were included. Average breast and abdominal drain duration were 12.9 ± 3.9 and 17.7 ± 8.2 days, respectively. Prolonged breast and abdominal drain duration were defined as drain use beyond the 75 th percentile at 14 and 19 days, respectively. Multivariable regression revealed hypertension was associated with an increased breast drain duration by 1.4 days (p  = 0.024), axillary dissection with 1.7 days (p  = 0.026), African-American race with 3.1 days (p  < 0.001), Hispanic race with 1.6 days (p  = 0.029), return to the OR with 3.2 days (p  = 0.004), and each point increase in BMI with 0.1 days (p  = 0.028). For abdominal drains, each point increase in BMI was associated with an increased abdominal drain duration by 0.3 days (p  = 0.011), infection with 14.4 days (p  < 0.001), and return to the OR with 5.7 days (p  = 0.007). Conclusion  Elevated BMI, hypertension, and axillary dissection increase risk for prolonged breast drain requirement in autologous reconstruction. African-American and Hispanic populations experience prolonged breast drain requirement after controlling for other factors, warranting further study. [ABSTRACT FROM AUTHOR]

Introduction: Incisional hernia is one of the common complications following abdominal surgery in patients undergoing laparotomy. Various surgical procedures are performed by creating a potential space and placing a foreign body (mesh), which may render the wound susceptible for many postoperative complications. It is clinically important to evaluate the efficacy of Incisional Negative Pressure Wound Therapy (INPWT) in reducing wound complications. Aim: To compare the efficacy of INPWT dressing with traditional gauze dressing in reducing postoperative complications following meshplasty in incisional hernia repair. Materials and Methods: This was a hospital-based randomised controlled trial, conducted in the Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, from October 2013 to July 2015. Total 64 consenting patients with incisional hernias undergoing meshplasty were included in this study. After being randomised into the two study groups, they had their postoperative wounds dressed with either INPWT (group A) for five days, or traditional gauze (group B) based dressings. Operative parameters like duration of surgery, type of dissection and type of skin sutures used were studied and analysed. Also, postoperative outcomes like Surgical Site Infection (SSI), seroma, duration of drain, hospital stay were analysed using Chi-square or Fisher’s-exact test. Results: Group A and B had the mean age of 47±11.61 years and 43±10.53 years respectively. Out of total 64 patients, there was a statistically significant reduction in the volume of drain (p=0.004) and duration of wound drainage (p=0.029) with the use of INPWT. There was also a reduction in the incidence of SSI (6.7% vs 17.6%) and seroma (6.7% vs 11.8%) and the duration of postoperative hospital stay (6.03±1.99 days vs 7.09±2.31 days) in the INPWT group, which were however not statistically significant. Age, co-morbidities, Body Mass Index (BMI), duration of surgery, type of dissection and type of skin sutures were not found to have any effect on the parameters assessed. Conclusion: Incisional negative pressure wound therapy in postoperative wounds, following meshplasty for incisional hernia significantly reduces the volume and duration of wound drainage. It also reduces the incidence of SSI, seroma and the duration of hospital stay.

The present study was conducted to investigate the potential of the free-floating macrophytes Pistia stratiotes to remediate nutrients and restore the eutrophic drain (Al-Sero Drain), South Nile Delta, Egypt. Plant and water samples were collected monthly for ten months using three randomly distributed quadrats in each of three sites. Monthly significant variation in all investigated water nutrients was recorded. The plant biomass showed bell-shaped distribution, with the lowest shoot and root biomass during May, while their peaks were during September. The plant shoots accumulated higher concentrations of most nutrient elements, except Mg, than the roots. The order of nutrients concentration (%) in P. stratiotes shoot was K > N > Ca > Na > Mg > P, while in the root was K > N > Na > Ca > Mg > P. Most nutrients standing stock (g/m−2) had the same biomass trend with the minimum during May and the maximum during August–October, which is the potential period for mowing the plant to remediate the highest nutrients and restore the eutrophic watercourses. Most investigated nutrients (except Ca) content in water were significantly correlated to their concentration in the different plant organs, which in turn provide a quantitative assessment of the environmental quality that suggests the potential use of this plant as a biomonitor of nutrient elements in eutrophic watercourses. [ABSTRACT FROM AUTHOR]

A one- year seasonal study was carried out to estimate the algal population and its biochemical contents in Lake Qarun in Egypt. Twelve samples representing Lake Qarun and two drains (El-Bats and El-Wadi) were examined. Bacillariophyta was the most dominant in phytoplankton assemblages. The highest seasonal phytoplankton density was recorded during summer, whereas the lowest was in autumn. The lowest spatial phytoplankton density, chlorophyll (a), and carotenoid concentrations were recorded in drains. ANOVA revealed significant differences between seasons and stations in the density of phytoplankton species, protein, carbohydrate, and lipid. Principal component analysis (PCA) results showed that water temperature was positively correlated with Ochrophyta, Cyanobacteria, Cryptophyta and some dominant phytoplankton species, meanwhile; water temperature was negatively correlated with Bacillariophyta, some dominant phytoplankton species, Chl (a), carotenoid, protein, carbohydrate, and lipid. Hence, water temperature and nutrients (NO3 and PO4), drained into the lake, play a major role in the trophic state changes of Lake Qarun, and its effect on the phytoplankton community and other environmental conditions was detected during the seasons of the year. [ABSTRACT FROM AUTHOR]

The research presented herein was carried out in the framework of the H2020 LIQUEFACT project (http://www.LIQUEFACT.eu/). This paper presents the results of a set of numerical analyses performed to study the soil-structure interaction in presence of a liquefiable soil. In the first part of the paper, the attention was focused on the ability of some advanced soil constitutive models to simulate the centrifuge tests carried out within the project. Two finite element codes, Plaxis 2D and OpenSees, were used for the computations. The results were analysed in terms of accelerations, displacements and pore pressures build up. In the second part of the paper the effects of the introduction of horizontal drains, as mitigation techniques against liquefaction, were shown and discussed in terms of their ability in reducing pore pressure build-up and building settlement. All the numerical predictions confirmed the experimental evidence that horizontal drains are able to reduce the excess pore pressure during shaking and the structural settlement. The amount of reduction depends on the water boundary condition at surface: a free seepage surface generally allowed a larger mitigation than where the liquefiable layer was topped by clay. [ABSTRACT FROM AUTHOR]

Inappropriate antibiotic use not only amplifies the threat of antimicrobial resistance (AMR), moreover exacerbates the spread of resistant bacterial strains and genes in the environment, underscoring the critical need for effective research and interventions. Our aim is to assess the prevalence and resistance characteristics of β-lactam resistant bacteria (BLRB) and β-lactamase resistant bacterial genes (BLRBGs) under various environmental conditions within Delhi NCR, India. Using a culture-dependent method, we isolated 130 BLRB from 75 different environmental samples, including lakes, ponds, the Yamuna River, agricultural soil, aquatic weeds, drains, dumping yards, STPs, and gaushalas. Tests for antibiotic susceptibility were conducted in addition to phenotypic and genotypic identification of BLs and integron genes. The water and sediment samples recorded an average bacterial abundance of 3.6 × 106 CFU/mL and an average ampicillin-resistant bacterial count of 2.2 × 106 CFU/mL, which can be considered a potent reservoir of BLRB and BLRBGs. The majority of the BLRB discovered are opportunistic pathogens from the Bacillus, Aeromonas, Pseudomonas, Enterobacter, Escherichia, and Klebsiella genera, with Multiple Antibiotic Resistance (MAR) index ≥0.2 against a wide variety of β-lactams and β-lactamase (BLs) inhibitor combinations. The antibiotic resistance pattern was similar in the case of bacteria isolated from STPs. Meanwhile, bacteria isolated from other sources were diverse in their antibiotic resistance profile. Interestingly, we discovered that 10 isolates of various origins produce both Extended Spectrum BLs and Metallo BLs, as well as found harboring bla TEM , bla CTX , bla OXA , bla SHV , int-1, and int-3 genes. Enterobacter cloacae (S50/A), a common nosocomial pathogen isolated from Yamuna River sediment samples at Nizamuddin point, possesses three BLRBGs (bla TEM , bla CTX , and bla OXA) and a MAR index of 1.0, which is a major cause for concern. Therefore, identifying the source, origin and dissemination of BLRB and BLRGs in the environment is of the utmost importance for designing effective mitigation approaches to reduce a load of antimicrobial resistance factors in the environmental settings. [Display omitted] • Emergence of BLRB and BLRGs in the environment settings of Delhi-NCR. • Waterbodies with high abundances (2.2 × 106 CFU/mL) of BLRB due to human impact. • STPs, Yamuna Rivers and Waterbodies are observed to be major hotspots for BLRBs. • BLRBs from different sources are 100% resistance for penicillin and cefazolin. • Enterobacter cloacae from Yamuna River sediments recorded MRD index of 1.0. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association of post-RP drain placement with post-operative complications and opioid use at a high-volume institution. Methods: A prospective, comparative cohort study of patients undergoing robot-assisted or open RP was conducted. Patients for two surgeons did not routinely receive pelvic drains ("No Drain" arm), while the remainder routinely placed drains ("Drain" arm). Outcomes were evaluated at 30 days including Clavien–Dindo complications and opioid use. Intention-to-treat primary analysis and additional secondary analyses were performed using appropriate statistical tests and logistic regression. Results: Of 498 total patients, 144 (28.9%) were in the No Drain arm (all robot-assisted) and 354 (71.1%) in the Drain arm. In the No Drain arm, 19 (13.2%) intraoperatively were chosen to receive drains. There was no difference in overall or major (Clavien ≥ 3) complications between groups (p = 0.2 and 0.4, respectively). Drain deferral did not predict complications on multivariable analysis adjusted for age, BMI, comorbidities, clinical risk, surgical approach, operating time, lymphadenectomy, and number of nodes removed [OR 0.61, 95% CI 0.34–1.11, p = 0.10]; nor did it predict symptomatic fluid collection, adjusting for lymphadenectomy and nodes removed [OR 1.14, 95% CI 0.43–3.60, p = 0.8]. Drain deferral did not decrease opioid use (p = 0.5). Per protocol analysis and restriction to robot-assisted cases demonstrated similar results. Conclusion: There was no difference in adverse events, complications, symptomatic collections, or opioid use with deferral of routine drain placement after RP. Experienced surgeons may safely defer drain placement in the majority of robot-assisted RP cases. [ABSTRACT FROM AUTHOR]

Artificial channels are common features in lowland agricultural catchments, and are a potentially significant habitat for aquatic species. Recent studies have suggested communities in managed rivers and artificial channels are broadly similar, but with some compositional differences. However, because relatively few studies have considered how artificial channels may contribute to supporting aquatic communities, their physicochemical condition and suitability for aquatic fauna remain poorly characterised. Therefore, this study explores the role of physicochemical variables in driving macroinvertebrate community differences between intensively managed rivers and artificial channels in a highly arable catchment. Aquatic macroinvertebrates were sampled in intensively managed rivers and artificial channels. Physicochemical water quality variables were also recorded, and used to identify macroinvertebrate community responses. Both intensively managed rivers and artificial channels had spatiotemporally stable communities, with no significant differences in richness, abundance, effective diversity or Berger–Parker dominance detected between sampling months or channel types. Macroinvertebrate composition in intensively managed rivers and artificial channels was significantly different, and driven by the relative abundance of taxa present, not the number of taxa unique to each channel type. Compositional differences between intensively managed rivers and artificial channels were partially driven by conductivity, dissolved oxygen and temperature. Identifying remaining sources of compositional variance may support tailored management strategies that accentuate compositional differences between rivers and artificial channels, increasing overall diversity in intensively farmed arable catchments. [ABSTRACT FROM AUTHOR]

Background: Bacterial infections are a common complication after liver transplantation. Usually, abdominal drains are placed at the end of the surgical procedure. The usefulness of routine drain tip culture has not been investigated. Patients and Methods: This retrospective study included 200 liver transplants between 2010 and 2015. We excluded patients without drain tip culture and those with abdominal or systemic complications before removal of drains. Demographic, clinical (pre-transplant, peri-operative and post-transplant) and microbiologic information were collected up to 30 days after operation. Three-month survival and re-transplantation were recorded. Results: There were 94 patients included. Drain tip culture was positive in 78 (83%) patients. The most common isolates were coagulase-negative staphylococci (30.9%), mixed gram-positive cocci (13.8%), and polymicrobial (21.3%). In 26 patients, 35 post-operative infections developed, with no differences between recipients with and without positive drain tip culture (22.8% vs. 25%; p > 0.99). In two patients, Staphylococcus aureus was isolated in drain tip cultures and in cultures confirming the post-operative infection (one catheter-related bacteremia and one drain-related peritonitis). In two other recipients, the positive drain tip culture had an impact on clinical management. All patients survived. Conclusions: Routine drain tip culture in asymptomatic liver recipients seems unhelpful. It may be more reasonable to perform it only in patients with suspicion of complications. [ABSTRACT FROM AUTHOR]

COMPARISON BETWEEN SINGLE DRAIN VERSUS TWO DRAINS IN THE PREVENTION OF POSTMASTECTOMY SEROMA Ahmed N Abdulnabi MB,ChB, CABS, Specialist Surgeon, Al-Fayhaa General Hospital, Basrah, IRAQ. Abstract Breast cancer is managed with many surgical options. Modified radical mastectomy with axillary dissection is the commonest procedure done nowadays. It is not free from complications, where seroma one of these. A comparative study was conducted to evaluate the effectiveness of single delayed removed drain versus two drains early removed for the prevention of seroma formation. One hundred and fifty patients were treated by modified radical mastectomy with axillary dissection for breast cancer between January 2010 and September 2016 in Al-Fayhaa General Hospital. Patients were divided into two groups, fifty patients were managed with single drain left for nine to ten days and the other one hundred patients had two drains removed after five days for prevention of seroma formation under mastectomy flaps. The highest age group affected by breast cancer was the 36-45 years and the lowest one was the 25-35 years. The incidence of seroma was 12% for the first group and 30% for the second one. The wound infection slightly more in the first group (14%) when compared with the other group (12%). In conclusion, the use of single drain for slightly longer time is better than two drains removed early in the prevention of seroma formation.

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Aim: Postoperative drains have historically been used for the prevention and early detection of intra‐abdominal collections. However, current evidence suggests that prophylactic drain placement following colorectal surgery has no significant clinical benefit. This is reflected in the enhanced recovery after surgery (ERAS) guidelines, which recommend against their routine use. The Ileus Management International study found more than one‐third of participating centres across the world routinely used drains in the majority of colorectal resections. The aim of the present study is to audit international compliance with ERAS guidelines regarding the use of postoperative drains in colorectal surgery. Method: This prospective, multicentre audit will be conducted via the student‐ and trainee‐led EuroSurg Collaborative network across Europe, South Africa and Australasia. Data will be collected on consecutive patients undergoing elective and emergency colorectal surgery with 30‐day follow‐up. This will include any colorectal resection, formation of colostomy/ileostomy and reversal of stoma. The primary end‐point will be adherence to ERAS guidelines for intra‐abdominal drain placement. Secondary outcomes will include the following: time to diagnosis of intra‐abdominal postoperative collections; output and time to removal of drains; and 30‐day postoperative complications defined by the Clavien–Dindo classification. Conclusion: This protocol describes the methodology for the first international audit of intra‐abdominal drain placement after colorectal surgery. The study will be conducted across a large collaborative network with quality assurance and data validation strategies. This will provide a clear understanding of current practice and novel evidence regarding the efficacy and safety of intra‐abdominal drain placement in colorectal surgical patients. [ABSTRACT FROM AUTHOR]

Introduction: The use of drains continues to be a controversial topic in surgery. In a review of that topic for incisional hernia it was not possible to find sufficient evidence of the need for a drain. Likewise, for inguinal hernia surgery the data available are insufficient. Methods: In a multivariable analysis of data from the Herniamed Registry for 98,321 patients with primary elective unilateral inguinal hernia repair in men, the role of a drain was investigated. Results: A drain was used in 24.7% (n = 24,287/98,321) of patients. These patients were on average older, had higher BMI, longer operating time and received a smaller mesh. Drains were also used more often for patients with higher ASA score, risk factors, larger defects and scrotal hernia localization as well as for Lichtenstein, TEP and suture repair. The use of drains was highly significantly associated with intra- and postoperative complications as well as with complication-related reoperations. Hence, drains are used selectively in inguinal hernia repair for patients at higher risk of perioperative complications. Despite the use of drains, the outcome in this risk group is less favorable. It remains unclear if drains prevent further complications in high-risk patients. Conclusion: Drains are used selectively in high-risk men with primary elective unilateral inguinal hernia repair. Drains are associated with intra- and postoperative complications rates and complication-related reoperation rate. Drains can serve as an indicator for early detection of complications. [ABSTRACT FROM AUTHOR]