Browsing by Author "Rayamajhi, Shreya"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Open Access
    An audit of emergency hernia operations: Surrogate of system failure or incidentalomas?
    (2020) Nkgudi, Boitumelo; Kloppers, Jacobus; Rayamajhi, Shreya
    Background: Hernia emergencies common surgery. Around 20 million groin hernia operations occur world-wide, and these form 70% of all hernia operations. Incisional hernias complicate 15- 30% of laparotomies and 20% of these present as emergencies. Watchful waiting is often applied for groin, ventral and incisional hernias in patients who are asymptomatic or those who are poor surgical candidates. The factors associated with poor outcomes include - elderly patients, multiple comorbidities, delays in presentation, those which are incarcerated or strangulated and delays in getting to theatre. Management of emergency hernias include resuscitative efforts to address life threatening problems, and thereafter performing the safest and most durable repairs. Aim: We aim to elucidate patient and health care systems factors that contribute to hernia emergency presentations and to document the mortality and morbidity of such presentations in our unit. Method: We aim to review case files of all patients above 18 years of age who had their emergency surgery for a complicated hernia. All elective cases will be excluded. Conclusion: This study will contribute to understanding emergency hernias in south Africa and will seek to improve patient care in our setting. A hernia registry has recently been established and thus we will be able to contribute to its foundation.
  • No Thumbnail Available
    Item
    Open Access
    Comparing mortality calculators for emergency laparotomy in Cape Town
    (2023) Awasthi, Neha; Rayamajhi, Shreya
    Introduction Emergency laparotomies (EL) are high risk surgeries, a result consistent across multiple national databases and audits. Risk prediction calculators (RPC) were developed to accurately stratify risk of mortality in these emergency patients, often frail prior to surgery. Access to post-operative care including high-care and Intensive Care Unit is limited in LMIC hospitals. Aims and Methods To determine the risk of mortality following surgery using three risk prediction calculators – namely National Emergency Laparotomy Audit's New Risk Prediction Calculator (NELANRPC), Portsmouth Physiological and Operative Society Score (P-POSSUM), and African Surgical Outcomes Study (ASOS) to 215 patients who underwent non-trauma EL in a tertiary level hospital in South Africa. Results Mortality on post-operative day 30 in this cohort was 24.2%. Colorectal resections were most performed and had the highest mortality rate (30.6%). For risk prediction calculators, the NRPC had the largest AUC-ROC (0.86 95% CI, 0.803 to 0.920), followed by P-POSSUM (0.84 95% CI, 0.780 to 0.899), and ASOS (0.806 95% CI, 0.74 to 0.87) having the least.
  • Thumbnail Image
    Item
    Open Access
    Penetrating femoral artery injuries : an urban trauma center experience
    (2017) Rayamajhi, Shreya; Navsaria, Pradeep H
    INTRODUCTION: The femoral artery (FA) is the most common peripheral vessel injured in trauma. The incidence has been as high as 70%. Most experience with vascular trauma comes from the military where the incidence of FA injury is 67% of all vascular injuries. Up to 88% of these injuries are as a result of penetrating trauma. The Groote Schuur hospital trauma unit is a level one centre. It is a quaternary hospital and a referral center for all surrounding secondary level hospitals. Femoral vessel injuries are the second most common peripheral vascular injury (18.8%) seen after brachial artery injuries (48.2%) at our unit. AIM: This study aims to review a single centre experience with femoral artery injuries and identify factors associated with limb loss. METHOD: A 11 year retrospective chart review of patients with femoral artery injuries managed from 1 January 2002 to 31 December 2012 at the trauma unit, GSH. RESULTS: There were 158 patients with femoral artery injuries, 144 men and 14 women with a mean age of 28. Ninty-five percent had penetrating injuries. The most common artery injured was the superficial femoral artery (87%). The most common type of arterial injury was a laceration (39%) and transection (37%). Eighty-one patients had a primary repair (51%), fifty-three patients had a vein interposition graft (33.5%) and sixteen patients (10%) had a prosthetic graft. There were 78 (51%) concomitant venous injuries, 11 were repaired and 1 vein patch was done (15.4%). The rest were ligated (84.6%). There were 4 (2.5%) primary amputations and 10 (6.5%) secondary amputations. One primary amputation resulted from a delay to theatre with a threatened limb. The other three presented with a non-viable limb. Nine of the ten secondary amputations presented with a threatened limb. One viable limb was lost due to bleeding from a false aneurysm secondary to sepsis. One secondary amputation was the result of a delayed fasciotomy for compartment syndrome post revascularisation of a threatened limb. The rest were due to prolonged ischemic time despite attempted revascularization. There were no deaths in this study. Univariate analysis showed that statistically significant risk factors for secondary amputation were: presentation with signs of a threatened (ischemic) limb (p<0.0001), the temporary vascular shunt group (p<0.001) and the lack of a palpable distal pulse post repair (p<0.01). Statistically insignificant factors were: concomitant femur fracture, compartment syndrome, fasciotomy, unstable hemodynamics on presentation, venous ligation and 'In hospital ischemia time'. CONCLUSION: The outcome of threatened limbs due to femoral vessel injury is good provided there is no delay to surgery. This study has a primary amputation rate of 2.5% and secondary amputation rate of 6.5%, 91% of the limbs were salvaged.
  • Thumbnail Image
    Item
    Open Access
    Upper gastrointestinal bleed: a comparative outcomes study of pre and post implementation of management guidelines in the acute care surgery unit, Groote Schuur Hospital
    (2019) Aborkis, Ismail; Rayamajhi, Shreya; Thomson, Sandie
    Background: Upper gastrointestinal bleeding (UGIT) is a common presentation to hospital and can result in a significant morbidity, mortality and hospital costs. Consensus guidelines are present from various international expert bodies regarding the management of these patients and compliance with these guidelines is variable and is dependent on rigorous implementation and continuous audits. Aim: The primary aim of this study is to evaluate complaints to three aspects of management of UGITB (time of endoscopy ,use of dual endotherapy and haemoglubin trigger for transfusion) at Acute Care Surgery Unit, at Groote Schuur Hospital. Methods: This is a comparative study between a retrospective control group and a prospective cohort post implementation of a quality improvement program (QIP). Results: This study included 109 patients, 51 in the control and 58 in the QIP group. The two groups were statistically comparable in terms of demographics, clinical presentation, referral pattern and endoscopy finding. Over 80% in both groups had their endoscopy within 24 hours (Control 83.7%, QIP 81.6%). Time to endoscopy was not statistically significantly different between the Control and QIP groups for low and high-risk patients ((suspected varices or Modified Glasgow-Blatchford Score (MBS) >10)). However, when both groups are combined, patients with an MBS of >10 or more had a statistically shorter 'Time to scope’ by 8 hours than those with a score < 10 (p=0.02).