Objective
To better define the shift in the management of renal trauma throughout the United
States, with a population-based assessment of community hospital practice patterns.
To investigate how hospital, patient, and injury-specific factors influence management
strategy by both urologists and nonurologists.
Materials and Methods
Using the Premier Hospital database, we performed a retrospective study of all patients
with renal trauma between 2003 and 2013. We identified patients using International
Classification of Diseases, Ninth Revision diagnosis codes (866.0x, 866.1x), determined
management strategy by International Classification of Diseases, Ninth Revision procedure
codes, and dichotomized grouping by surgeon specialty. We stratified hospitals by
annual renal trauma volume categorized a priori into low, <10 cases per year; intermediate,
10-20 cases per year; and high, >20 cases per year. We performed descriptive statistics
and univariate and multivariate regression analyses adjusting for survey weighting
and for patient, hospital, and injury-specific characteristics.
Results
Our study cohort included a weighted sample size of 21,531 patients. Higher renal
trauma hospitals (12.6%) were significantly less likely than low (26.4%) and intermediate
(31.3%) volume hospitals to undergo surgical intervention for renal trauma on adjusted
models. There was a statistically significant increase in nonoperative management
from 65.2% in 2003 to 81.8% in 2013.
Conclusion
National rates of surgical intervention for renal trauma are significantly higher
than those frequently quoted by the literature, especially among low- and intermediate-volume
renal trauma hospitals. Although operative rates are decreasing, further consideration
may need to be given to centralization of care in higher-volume teaching hospitals
to improve renal salvage.
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Article info
Publication history
Published online: July 12, 2016
Accepted:
June 30,
2016
Received:
March 31,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Previously presented at the New England Section, American Urological Association, Annual Meeting, 2013, Hartford, CT, and at the National Meeting, American Urological Association, Annual Meeting, 2014, Orlando, FL.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
