monty khajanchi - Academia.edu (original) (raw)

Papers by monty khajanchi

World Journal of Surgery, 2021

Background Renal trauma is present in 0.5–5% of patients admitted for trauma. Advancements in rad... more Background Renal trauma is present in 0.5–5% of patients admitted for trauma. Advancements in radiologic imaging and minimal-invasive techniques have led to decreased need for surgical intervention. We used a large trauma cohort to characterise renal trauma patients, their management and outcomes. Methods We analysed “Towards Improved Trauma Care Outcomes in India” cohort from four urban tertiary public hospitals in India between 1st September 2013 and 31st December 2015. The data of patients with renal trauma were extracted using International Classification of Diseases 10 codes and analysed for demographic and clinical details. Results A total of 16,047 trauma patients were included in this cohort. Abdominal trauma comprised 1119 (7%) cases, of which 144 (13%) had renal trauma. Renal trauma was present in 1% of all the patients admitted for trauma. The mean age was 28 years (SD-14.7). A total of 119 (83%) patients were male. Majority (93%) were due to blunt injuries. Road traffic ...

OTO Open

Objective The pattern of head and neck injuries has been well studied in high-income countries, b... more Objective The pattern of head and neck injuries has been well studied in high-income countries, but the data are limited in low- and middle-income countries, which are disproportionately affected by trauma. We examined a prospective multicenter database to describe patterns and outcomes of head and neck injuries in urban India. Study Design Retrospective review of trauma registry. Setting Four tertiary public hospitals in Mumbai, Delhi, Kolkata. Methods We identified patients with isolated head and neck injuries using International Classification of Diseases, 10th Revision ( ICD-10) codes and excluded those with traumatic brain and/or ophthalmic injuries and injuries in other body regions. Results Our cohort included 171 patients. Most were males (80.7%) and adults aged 18 to 55 years (60.2%). Falls (36.8%) and road traffic accidents (36.3%) were the 2 predominant mechanisms of injury. Overall, 35.7% required intensive care unit (ICU) admission, and 11.7% died. More than 20% of pati...

Injury

ysis. Females were also less likely to require a ventilator (17.3% vs 21.0% males, p = 0.001) or ... more ysis. Females were also less likely to require a ventilator (17.3% vs 21.0% males, p = 0.001) or ICU admission (34.4% vs 37.5%, p = 0.028). Stratification by age or by ISS demonstrated no difference in 30-day in-hospital mortality for males vs females across age and ISS categories. On multivariable regression analysis, sex was not associated significantly with 30-day or 24-hour in-hospital mortality. Conclusion This study did not demonstrate a significant difference in the 30-day trauma mortality or 24-hour trauma mortality between female and male trauma patients in India on adjusted analyses. A more granular data is needed to understand the interplay of injury severity, immediate post-traumatic hormonal and immunological alterations, and the impact of gender-based disparities in acute care settings.

Journal of Surgical Research

$Research paper thumbnail of How are left-sided rib fractures associated with splenectomy in cases of splenic injury? A multicentre cohort study from urban India$

Background Any fracture to the rib cage, particularly the left sided ribs, implies a high impact ... more Background Any fracture to the rib cage, particularly the left sided ribs, implies a high impact trauma and higher predisposition to splenic injury. Our hypothesis is that injuries causing fractures to the left sided ribs may indicate a high-grade splenic injury which may require splenectomy. This would help the surgeon working in rural and limited resource settings, to plan splenectomy in hemodynamically stable patients with an undetermined grade of splenic injury. With this hypothesis in mind, we aimed to determine how fractures to the left sided ribs, in cases of splenic injury, are associated with splenectomy. Methods We performed a subgroup analysis of patients with splenic injury from a prospective trauma registry study named ‘Towards Improved Trauma Care Outcomes’ in India. Categorical variables were analyzed using the chi square test and a binary logistic regression was developed to assess the significance of continuous variables. Results During the study period, a total of ...

BackgroundMost trauma societies recommend intubation of trauma patients with Glasgow coma scale (... more BackgroundMost trauma societies recommend intubation of trauma patients with Glasgow coma scale (GCS) ≤ 8, without robust evidence supporting it.MethodsWe examined the association between intubation and inhopital 30 day mortality in trauma patients arriving with GCS ≤ 8. The data were obtained using the Towards Improved Trauma Care Outcomes (TITCO) registry in India cohort. We compared the outcomes of patients with GCS ≤ 8 who were intubated within one hour after arrival with those who were intubated later or not at all, using multiple analytical approaches to evaluate the consistency of the findings. We also examined the association in multiple subgroups to identify any variability of the effect.ResultsOf 3476 patients who arrived with a GCS ≤ 8, 1671 (48.1%) were intubated within an hour and 1805 (51.9%) were intubated later or not intubated at all. Overall, 1957 (56.3%) patients died in whole cohort. A total of 947 (56.7%) patients died in intubation group and 1010 (56%) died in ...

The Lancet Neurology, 2022

BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a sub... more BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.

Social Science Research Network, 2018

Impact of COVID-19 on surgical care delivery across Indian Hospital. Period of study April 2019 w... more Impact of COVID-19 on surgical care delivery across Indian Hospital. Period of study April 2019 with "control" period as April 2020.

Supplemental material for Both the multiplicative and single-worst-injury International Classific... more Supplemental material for Both the multiplicative and single-worst-injury International Classification of Diseases Injury Severity Score underperform in urban Indian hospitals by Mattias Sterner, Jonatan Attergrim, Alice Claeson, Vineet Kumar, Monty Khajanchi, Satish Dharap and Martin Gerdin in Trauma

Background: Surgical site infections (SSIs) affect around a third of patients undergoing surgerie... more Background: Surgical site infections (SSIs) affect around a third of patients undergoing surgeries worldwide, annually. It is heterogeneously distributed with a higher burden in low and middle-income countries. Although rural and semi-urban hospitals cater to 60-70% of the Indian population, scarce data regarding SSI rates are available from such hospitals. The study aimed to determine the prevalent SSI control practices and existing SSI rates in the smaller rural and semi-urban hospitals in India. Methods: This is a prospective study performed in two phases involving surgeons and their hospitals from Indian rural and semi-urban regions. In the first phase, a questionnaire was administered to surgeons enquiring into the perioperative SSI prevention practices and five interested centres were recruited for phase two which documented the rate of SSIs and factors affecting them, Results: There was full compliance towards appropriate perioperative sterilisation practices and postoperativ...

Search strategy for MEDLINE and EMBASE. Tables describing preliminary search strategy and results... more Search strategy for MEDLINE and EMBASE. Tables describing preliminary search strategy and results for MEDLINE and EMBASE searches. (PDF 102Â kb)

Data collection form. Form for extracting data from eligible articles. (PDF 145Â kb)

Hemosuccus Pancreaticus (HP) is a rare & potentially life threatening clinical entity. It is desc... more Hemosuccus Pancreaticus (HP) is a rare & potentially life threatening clinical entity. It is described as bleeding from Ampulla of Vater via the Pancreatic Duct (PD).This condition is classically attributed to erosion of Splenic artery Aneurysm into the PD or bleeding into a pseudocyst as a result of Acute or Chronic Pancreatitis causing intermittent severe upper gastrointestinal (GI) bleeding. It poses a significant diagnostic & therapeutic dilemma because of its rarity, anatomic location & intermittency of bleeding. When Obscure GI bleeding is encountered, HP should be considered in cases of pancreatitis. Mesenteric Angiographic intervention remains the modality of choice for diagnosis & treatment. However if embolization of bleeding vessel fails, emergency surgery should be undertaken. We describe our experience with a case of HP who presented to us with hematochezia with hemodynamic instability and the diagnostic as well as therapeutic difficulties faced.

British Journal of Surgery, 2021

PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 check... more PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist. Recommended items to address in a systematic review protocol. (PDF 104Â kb)

Background: Pancreatic trauma occurs in 0.2-2% of patients with blunt trauma and 1–12% of patient... more Background: Pancreatic trauma occurs in 0.2-2% of patients with blunt trauma and 1–12% of patients with penetrating trauma. The mortality and morbidity rates range from 9-34% and 30-60% respectively. We aimed to review the management of pancreatic trauma in a multicenter database from India.Methods: We analyzed all patients who suffered a pancreatic injury and who were included in the multicenter prospective observational study ‘Towards Improved Trauma Care Outcomes (TITCO)’.Results: Of the 16047 trauma cases, 1134 (7.1%) patients suffered abdominal trauma. Of all those with abdominal trauma 55 patients (4.9%) had injury to the pancreas. 28 patients (50.9%) with pancreatic trauma were managed conservatively. 27 patients (49.1%) underwent surgical exploration in the form of laparotomies. 11 procedures were undertaken for pancreas. A total of 45 (82%) patients had associated injuries along with pancreatic injury. Thorax (19) (including injuries to lung, pleura and ribs), liver (17), b...

Background: It is well established that disease-free survival and overall survival after breast c... more Background: It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient’s choice, availability and accessibility of infrastructure and surgeon’s choice. We aimed to elucidate the Indian surgeons’ perspective while choosing between BCS and mastectomy, in women oncologically eligible for BCS. Methods: We conducted a survey-based cross-sectional study over 3 weeks between January-February 2021. Indian surgeons with general surgical or specialised onco-surgical training, who consented to participate were included in the study. Multinomial logistic regression was performed to assess the effect of study variables on offering mastectomy or BCS to an eligible patient.Results: A total of 347 responses were included. The mean age of the participants was 43...

Injury, 2021

SpO2 < 90%), Tachypnoea (RR > 20brpm) and severe (3-8) and moderate (9-12) GCS having strong asso... more SpO2 < 90%), Tachypnoea (RR > 20brpm) and severe (3-8) and moderate (9-12) GCS having strong association with 24-hour mortality. Notably, the patients with missing values for SBP, HR and RR also demonstrated higher odds of 24-hour mortality. The Injury Severity Scores (ISS) did not corelate with 24-hour mortality. Conclusion: The routinely measured GCS and vital signs including SBP, HR, SpO2 and RR are independently associated with 24-hour in-hospital mortality in the context of university hospitals of urban India. These easily measured parameters in the emergency setting may help improve decision-making and guide further management in the trauma victims. A poor short-term prognosis was also observed in patients in whom these physiological variables were not recorded.