Surgeons
15 years of experience
Video profile
Accepting new patients
Royal Oak
3535 W 13 Mile Rd
Royal Oak, MI 48073
248-551-9090
Locations and availability (3)

Education ?

Medical School Score
The University of Texas at San Antonio (1995)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Associations
American Board of Surgery

Affiliations ?

Dr. Janczyk is affiliated with 6 hospitals.

Hospital Affilations

Score

Rankings

  • Beaumont Hospital,Troy
    44201 Dequindre Rd, Troy, MI 48085
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital, Grosse Pointe
    468 Cadieux Rd, Grosse Pointe, MI 48230
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital, Royal Oak
    3601 W 13 Mile Rd, Royal Oak, MI 48073
    • Currently 4 of 4 crosses
    Top 25%
  • Royal Oak 7 Years
  • Royal Oak
  • Beaumont Affiliation & Years on StaffRoyal Oak
  • Publications & Research

    Dr. Janczyk has contributed to 10 publications.
    Title Predictors of Mortality in Trauma Patients with Intracranial Hemorrhage on Preinjury Aspirin or Clopidogrel.
    Date November 2008
    Journal The Journal of Trauma
    Excerpt

    BACKGROUND: The mortality risk in elderly patients who sustained head trauma resulting in intracranial hemorrhage (ICH) while taking the antiplatelet agents aspirin (ASA) or clopidogrel or both (Plavix) was evaluated. METHODS: A retrospective review identified trauma patients, age 50 or greater, who had computed tomography (CT) evidence of ICH and were taking ASA, clopidogrel, or a combination of both. Patient demographics, type of medication, mechanism of injury, Glasgow Coma Score (GCS), grading of head CT scans, and outcomes were characterized. RESULTS: One hundred nine patients including 61 men and 48 women were identified; the mean age was 77 years +/- 10 years. Injury was due to level fall (73), fall from height (21), motor vehicle crash (11), and other (4). Twenty (18%) patients died; age, gender, type of medication, and mechanism of injury were not predictive of death. The initial GCS for survivors was 14.2 +/- 1.9 versus 11.3 +/- 4.9 for nonsurvivors (p < 0.007). Deaths based on initial CT grade were: grade 1, 5 of 70; grade 2, 4 of 17; grade 3, 5 of 10; grade 4, 6 of 12 (p = 0.002). Follow-up CT scans were performed in 81 patients who were not taken to surgery and had grade 1 or 2 hemorrhage initially. Of 4 patients with hemorrhage progression, there was 1 death (25%) versus 6 deaths in 77 patients without progression (8%; p = 0.70). CONCLUSIONS: There is high mortality rate associated with ASA or clopidogrel or both in elderly patients who have head trauma resulting in ICH. The presenting GCS and initial grade of CT scan are most predictive of death. Progression of hemorrhage after admission is unusual. The risk of brain injury, particularly from falls, should be explained to elderly patients taking these medications.

    Title Factors Affecting the Severity of Spontaneous Retroperitoneal Hemorrhage in Anticoagulated Patients.
    Date March 2008
    Journal American Journal of Surgery
    Excerpt

    BACKGROUND: Clinical manifestations of spontaneous retroperitoneal hemorrhage (SRH) range from a small decrease in hemoglobin to hypotension requiring transfer to the intensive care unit (ICU). Our goal was to identify which anticoagulated patients are at increased risk for SRH and its complications. METHODS: We conducted a retrospective review of 180 patients with SRH. Age, sex, presence of comorbidities, hemoglobin decrease, transfusion requirement, ICU stay, and length of ICU stay were recorded. Patients were divided into 5 groups based on their anticoagulants: (1) heparin and Coumadin, (2) heparin only, (3) Coumadin only, (4) heparin +/- Coumadin and aspirin (ASA) +/- Plavix, and (5) other anticoagulants. RESULTS: Group 4 patients were more likely to require ICU admission and have longer ICU stay compared to others (P = .021 & P < or = 0.0001, respectively, by Kruskall-Wallis test). Patients with coronary artery disease were more likely to require ICU admission (P = .01 by chi-square test). CONCLUSIONS: Patients on combined anticoagulant-antiplatelet therapy are more likely to require ICU admission and longer ICU stay. Close observation is warranted in these patients for early detection of SRH.

    Title Donation After Cardiac Death: Lessons Learned.
    Date May 2007
    Journal Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses
    Excerpt

    Despite the increasingly positive outcome of organ transplantation as an accepted treatment of end-stage organ diseases, an average of 15 people die each day awaiting organ transplantation. According to the United Network for Organ Sharing, there are more than 90,000 people in the United States waiting for an organ transplant.In the United States, less than 1% of all deaths are attributed to brain death. A single brain-dead organ donor has the potential to save up to 8 individuals by donating organs and providing up to 50 people with tissue and cornea transplants. The reality is that the source of available brain-dead donors does not meet the needs of the growing waiting list. To help deal with the increasing demand for organs, donation after cardiac death has been reintroduced to families of patients with catastrophic brain injuries. Families have the right to be informed of all potential end-of-life options, including that of organ donation and the use of donation after cardiac death when appropriate. Hospitals and healthcare workers must be committed to provide the option of donation after cardiac death for both donor families and transplant recipients. The purpose of this article is to examine the process of implementing a donation after cardiac death policy in a 1,061-bed tertiary care hospital with level I trauma designation.

    Title Improved Organ Procurement Through Implementation of Evidence-based Practice.
    Date March 2007
    Journal Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses
    Excerpt

    Michigan, like most other states in the nation, has a clear need for more organ donors for transplantation; at this time, there are more than 2,800 patients in the state awaiting organs. We have evaluated the effects of a process improvement program designed to increase the number of organ donors and the number of organs donated from appropriate trauma patients. In 2005, William Beaumont Hospital began working with the Michigan Hospital Association Keystone Center and more than 40 hospitals across Michigan to implement evidence-based practices in organ donation focused on 4 specific outcomes and process measures. Outcome measures were conversion rate and referral rate, whereas the process measures were timely notification rate and the rate of requests by appropriate requester. We have retrospectively reviewed our recent outcomes in regard to these measures and compared them with the outcomes for the same time period 1 year before implementation. The data for preimplementation (January-December 2004; 32 eligible donors) and postimplementation (January-December 2005; 30 eligible donors) are summarized below: [table: see text] In 2004, a total of 67 organs were made available to Gift of Life Michigan; in 2005, a total of 88 organs were made available, a 31% increase. Implementation of evidence-based practice initiatives can significantly increase the donor conversion rate. This has led to an overall increase in the number of organs available for transplant.

    Title Practice Patterns and Outcomes of Retrievable Vena Cava Filters in Trauma Patients: an Aast Multicenter Study.
    Date February 2007
    Journal The Journal of Trauma
    Excerpt

    BACKGROUND: The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS: A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 +/- 8 days after admission and retrieval at 50 +/- 61 days. Follow up after discharge (5.7 +/- 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION: Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.

    Title Treatment of Trauma Patients with Intracranial Hemorrhage on Preinjury Warfarin.
    Date September 2006
    Journal The Journal of Trauma
    Excerpt

    BACKGROUND: Preinjury warfarin anticoagulation has been shown to increase the mortality of traumatic intracranial hemorrhage. We have evaluated the impact on patient mortality of the rapid triage of patients at risk for warfarin associated traumatic intracranial hemorrhage. METHODS: A "Coumadin Protocol" was implemented in January, 2001 in the Emergency Department that expedited triage of anticoagulated trauma patients to immediate physician evaluation. Patient outcomes during a 2 year period were compared with a matched control group of similarly injured, anticoagulated patients who were treated before protocol initiation. RESULTS: Thirty-five patients were treated after implementation of the Coumadin Protocol. Mean time until warfarin reversal was 4.3 +/- 4.4 hours, and there was a 37% mortality. Twenty-two control patients had a mean time to reversal of 4.2 +/- 2.9 hours, with a 45% mortality (p = 0.610). Ten protocol patients were shown to have intracranial hemorrhage progression by computed tomography (CT) scan, with a 60% mortality rate. Seventeen patients had follow-up CT scan and showed no progression; only one of these patients (6%) died (p = 0.004). Hemorrhage severity based on the initial CT scan did not predict mortality or hemorrhagic progression. CONCLUSIONS: We conclude from these data that a trauma center protocol for rapid identification of intracranial bleeding without a concomitant therapeutic protocol does not improve survival in head injured patients on preinjury warfarin.

    Title Rapid Warfarin Reversal in Anticoagulated Patients with Traumatic Intracranial Hemorrhage Reduces Hemorrhage Progression and Mortality.
    Date February 2006
    Journal The Journal of Trauma
    Excerpt

    BACKGROUND: A prospective cohort study at our institution demonstrated a 48% mortality rate in warfarin anticoagulated trauma patients sustaining intracranial hemorrhage (ICH) compared with a 10% mortality rate in nonanticoagulated patients. Forty percent of patients demonstrated progression of their ICH, despite anticoagulation reversal, with a resultant 65% mortality rate. Seventy-one percent of these patients initially presented with a Glasgow Coma Scale (GCS) score > or = 14 and a 'minor' ICH. We postulated that early diagnosis of ICH and rapid anticoagulation reversal would reduce ICH progression rates and mortality. METHODS: All anticoagulated patients with known or suspected head trauma were entered into the Coumadin protocol. The protocol ensured immediate triage and physician evaluation, head computed tomography (CT) scan, and fresh frozen plasma administration in patients with documented ICH. RESULTS: Eighty-two patients were entered into the protocol with ICH documented in 19 (23%). Sixteen of 19 patients (84%) presented with GCS > or = 14. Median international normalized ratio (INR) for treated patients with ICH was 2.7 versus 2.5 for patients without ICH (p = 0.546). Mean time to initiate warfarin reversal was 1.9 hours for protocol patients versus 4.3 hours for preprotocol patients (p < 0.001). Two of 19 (10%) protocol patients with ICH died. However, both patients presented >10 hours after injury with a severe ICH. This 10% mortality rate is significantly less than the 48% mortality rate seen previously (p < 0.001) and is now consistent with that observed in similarly injured patients not on anticoagulation. CONCLUSION: Neither the initial GCS nor INR in anticoagulated trauma patients reliably identifies patients with ICH. Rapid confirmation of ICH with expedited head CT scan combined with prompt reversal of warfarin anticoagulation with fresh frozen plasma decreases ICH progression and reduces mortality.

    Title Spontaneous Retroperitoneal Hemorrhage.
    Date May 2005
    Journal American Journal of Surgery
    Excerpt

    BACKGROUND: We evaluated patients with spontaneous retroperitoneal hemorrhage for reliable predictors of early diagnosis and improved outcomes. METHODS: A retrospective chart review was done to determine patient demographic and laboratory findings, presenting symptoms, time to diagnosis, anticoagulant and/or antiplatelet agent use, transfusions, and patient outcome. RESULTS: One hundred nineteen patients were identified; 14 (12%) died (mean age 77 +/- 9 years vs. 74 +/- 10 years for survivors [P = 0.235]). All nonsurvivors were on anticoagulants: 8 of 89 (9%) were on heparin or warfarin alone, and 6 of 23 (26% [P = 0.028]) were on a combined anticoagulant-antiplatelet regimen. Symptom onset to computed axial tomography (CAT) scan averaged 1.3 +/- 1.3 days for nonsurvivors versus 1.5 +/- 1.9 days for survivors (P = 0.778). Hemoglobin was 9.07 +/- 3.35 for nonsurvivors versus 9.60 +/- 2.07 for survivors (P = 0.435). Eighty-eight patients were transfused, and 10 died; 31 patients had no transfusion, and 4 of these died (P = 0.821). CONCLUSIONS: A high index of clinical suspicion is necessary for diagnosis of spontaneous retroperitoneal hemorrhage because these patients present with a variety of symptoms. Prospective studies are necessary to determine whether earlier diagnosis combined with aggressive resuscitation can impact the high mortality rate seen in these patients.

    Title Hypothermia is an Independent Predictor of Mortality in Ruptured Abdominal Aortic Aneurysms.
    Date May 2004
    Journal Vascular and Endovascular Surgery
    Excerpt

    Hypothermia is known to significantly increase mortality in trauma patients, but the effect of hypothermia on outcomes in ruptured abdominal aortic aneurysms (RAAA) has not been evaluated. The authors reviewed their experience from 1990 to 1999 in 100 consecutive patients who presented with RAAA and survived at least to the operating room for surgical treatment. There were 70 men and 30 women, with a mean overall age of 74 +/-8 years. Overall mortality was 47%. Univariate ANOVA (analysis of variants) showed significant correlation with mortality for decreased intraoperative temperature, decreased intraoperative systolic blood pressure, increased intraoperative base deficit, increased blood volume transfused, increased crystalloid volume (all p < 0.001); decreased preoperative hemoglobin (p = 0.015); and increased age (p = 0.026). Patient sex, initial preoperative temperature, preoperative systolic blood pressure, and operating room time were not correlated with mortality in the univariate analysis. Using these same clinical variables, multiple logistic regression analysis showed only 2 factors independently correlated with mortality: lowest intraoperative temperature (p = 0.006) and intraoperative base deficit (p = 0.009). The mean lowest temperature for survivors was 35 +/-1 degrees C and for nonsurvivors 33 +/-2 degrees C (p < 0.001). When patients were grouped by lowest intraoperative temperature, those whose temperature was < 32 degrees C (n = 15) had a mortality rate of 91%, whereas patients with a temperature between 32 and 35 degrees C (n = 50) had a mortality rate of 60%. In the group that remained at or > 35 degrees C (n = 35) the mortality rate was only 9%. A nomogram of predicted mortality versus temperature was constructed from these data and showed that for temperatures of 36, 34, and 32 degrees C the predicted mortality was 15%, 49%, and 84%, respectively. The authors conclude that hypothermia is a strong independent contributor to mortality in patients with ruptured abdominal aortic aneurysms and that very aggressive measures to prevent hypothermia are warranted during the resuscitation and treatment of these patients.

    Title High-flow Venovenous Rewarming for the Correction of Hypothermia in a Canine Model of Hypovolemic Shock.
    Date November 2002
    Journal The Journal of Trauma
    Excerpt

    BACKGROUND: Continuous arteriovenous rewarming (CAVR) has been shown to effectively reverse hypothermia; however, its use is limited in the setting of profound hypotension. We have evaluated the effectiveness of high-flow venovenous rewarming (HFVR) using bypass for the correction of hypothermia in a hypotensive canine model and compared these results to CAVR. METHODS: Eight dogs, randomly assigned to either HFVR or CAVR, were cooled to a core temperature of 29.5 degrees C and then bled to a mean arterial pressure of 55 mm Hg. Rewarming was then initiated and the time required for blood, liver parenchyma, and esophageal (core) temperature to reach 36 degrees C was recorded. RESULTS: Mean flow rates were 1,536 +/- 667 mL/min for HFVR and 196 +/- 35 mL/min for CAVR (p = 0.007). Time in minutes to rewarm to 36 degrees C for the HFVR versus the CAVR groups, respectively, were as follows: blood, 12 +/- 2 versus 99 +/- 19; liver, 21 +/- 3 versus 102 +/- 16; and esophageal, 25 +/- 6 versus 125 +/- 17 (all < 0.001). CONCLUSION: HFVR is an effective method for rapid rewarming in a profoundly hypothermic, hypotensive animal model and may have clinical utility in patients presenting with hypovolemia/hypotension complicated by hypothermia.


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