Contemporary Management of Penetrating Renal Trauma - A National Analysis
Majed W. El Hechi MD1, Charlie Nederpelt BS1, Napaporn Kongkaewpaisan MD1, Alexander Bonde BS1, Nikolaos Kokoroskos MD1, Kerry Breen BS1, Ahmed Nasser MD1, Noelle N. Saillant MD1, Haytham M.A. Kaafarani MD, MPH1, George C. Velmahos MD, PhD1, April E. Mendoza MD, MPH 1
Background:
Indications for nonoperative management (NOM) after penetrating renal injury remain ill-defined. We sought to describe the national experience of NOM and determine risk factors for failure.
Methods:
The TQIP database 2010-2016 was used to identify patients with penetrating renal trauma. Outcomes were compared between patients treated with an immediate operation (IO) and those offered NOM. Failure of NOM was defined as the need for a renal operation after 4 hours from arrival. Univariate then multivariable regression analyses were performed to identify predictors of NOM failure.
Results:
Out of 8,139 patients with kidney trauma, 1,842 had a penetrating mechanism of injury and were included. Of those, 89% were male, median age was 28 years, and 330 (18%) were offered NOM. Compared to IO, NOM patients were less likely to have gunshot wound (59% vs 89% p<0.001) or high-grade renal injuries [AAST 4-5] (48% vs 76%, p<0.001). They also had lower odds of developing in-hospital complications and shorter ICU and hospital stays. NOM failed in 26 patients (8%). Independent predictors of NOM failure included a concomitant abdominal injury (OR=3.99, 95% CI 1.03 – 23.23, p=0.044), and every point increase in AAST grade (OR=2.43, 95% CI 1.27 – 5.21, p=0.005)
Conclusions:
NOM is highly successful in selected patients. Concomitant abdominal injuries and higher grade AAST injuries predict NOM failure and should be considered when selecting patients for IO or NOM.
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