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.

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Background: Heart Failure with Preserved Ejection Fraction (HFPEF) (EF ≥ 50%) is a challenge in clinical management due to the limited randomised trials showing improved outcomes and lack of evidence based guidelines to manage this increasingly common condition.Aims: To identify the proportion of HFPEF patients in the Management of Cardiac Function (MACARF) program and evaluate the impact of beta blockers (BB) on HF readmission rate (≥1) within one year of initial HF hospitalisation.Methods: We retrospectively analysed data from the MACARF database between the years 2007-2009 inclusive. A total of 1054 patients were initially hospitalised with HF in the seven Northern Sydney Area Health hospitals, of whom 400 (38%) had HFPEF (male -163 (41%), female -237 (59%)). Of these, 55% had prior ischemia.Results: The HFPEF patients were further classified into those discharged with beta-blockers (BB n = 199 patients, 49.75%) (female 60%) and those without beta-blockers (NB n = 201 patients, 50.25%) (female 58%). A major reason for not receiving BB was asthma (39%). Twelve month HF readmission rate for those on BB was 22.6% (n = 45), and not on BB was 22.9% (n = 46), p value = NS.Conclusions: In this observational study of HFPEF, betablocker therapy was not associated with a lower rate of heart failure readmission. Heart Failure with Preserved Ejection Fraction is common in the overall HF population (38%) particularly among women. Beta blockers was prescribed in half of the HFPEF population and its utility should be further defined in randomised prospective trials.

Abiotrophia defectiva is an uncommon and insidious yet destructive cause of infective endocarditis preferentially treated with penicillin/gentamicin and often requiring surgical treatment. A 60-year-old man with penicillin anaphylaxis history presented with fevers and a nonspecific constellation of symptoms. He was ultimately diagnosed with bicuspid aortic valve infective endocarditis based on blood cultures growing A.defectiva and echocardiographic evidence of bicuspid aortic valve, severe valvular regurgitation, and 5 × 7   mm vegetation. Aortic valve replacement and culture yielded penicillin-sensitive A.defectiva. After successful penicillin desensitization, antibiotic therapy was switched from vancomycin/gentamicin to benzylpenicillin. This is the first published case of penicillin desensitization in a patient with A.defectiva-associated infection. Penicillin desensitization, optimal antibiotic therapy, prompt aortic valve replacement, and close collaboration between cardiology and various other specialties were essential in achieving a positive outcome.