Abstract
Objective
To test the hypothesis that undergoing nephrectomy after high-grade renal trauma is
associated with higher mortality rates.
Methods
We gathered data from 21 Level-1 trauma centers through the Multi-institutional Genito-Urinary
Trauma Study. Patients with high-grade renal trauma were included. We assessed the
association between nephrectomy and mortality in all patients and in subgroups of
patients after excluding those who died within 24 hours of hospital arrival and those
with GCS≤8. We controlled for age, injury severity score (ISS), shock (systolic blood
pressure <90 mmHg), and Glasgow Coma Scale (GCS).
Results
A total of 1181 high-grade renal trauma patients were included. Median age was 31
and trauma mechanism was blunt in 78%. Injuries were graded as III, IV, and V in 55%,
34%, and 11%, respectively. There were 96 (8%) mortalities and 129 (11%) nephrectomies.
Mortality was higher in the nephrectomy group (21.7% vs 6.5%, P <.001). Those who died were older, had higher ISS, lower GCS, and higher rates of
shock. After adjusting for patient and injury characteristics nephrectomy was still
associated with higher risk of death (RR: 2.12, 95% CI: 1.26-2.55).
Conclusion
Nephrectomy was associated with higher mortality in the acute trauma setting even
when controlling for shock, overall injury severity, and head injury. These results
may have implications in decision making in acute trauma management for patients not
in extremis from renal hemorrhage.
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Article info
Publication history
Published online: August 23, 2021
Accepted:
July 6,
2021
Received:
May 27,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
