Contemporary trends in the immediate surgical management of renal trauma using a national database

Abstract

The National Trauma Data Bank was used to analyze open surgical management of renal trauma during the first 24 hours of hospital admission, excluding those who were treated with conservative measures. A descriptive analysis of initial management trends following renal trauma was also performed as a secondary analysis. With the use of the National Trauma Data Bank, patients with renal injuries were identified, and Abbreviated Injury Scale (AIS) codes were stratified to a corresponding American Association for the Surgery of Trauma (AAST) renal injury grade. Trends in initial management were assessed using the following initial treatment categories: observation, minimally invasive surgery, and open renal surgery. Analysis of initial open surgery was further examined according to etiology of injury (blunt vs. penetrating), type of open renal surgery, concomitant abdominal surgery, patient demographics, and time to surgery. A total of 9,002 renal injuries (0.3%) were mapped to an AAST renal grade. Of these, 1,183 patients underwent open surgery for their renal injury in the first 24 hours. There were 773 penetrating and 410 blunt injuries within this cohort. The majority of surgical patients sustained a high-grade renal injury (AAST Grades 4-5, 64%). The overall nephrectomy rate in the first 24 hours was 54% and 83% for the penetrating and blunt groups, respectively. While the overall nephrectomy rate for AAST Grade 1 to 3 renal injuries in the first 24 hours was low (1.8%), the nephrectomy rate was higher in the setting of an exploratory laparotomy (30%). Of those undergoing renal surgery in the first 24 hours, 86% had concomitant surgery performed for other abdominal injuries. Mean time from emergency department presentation to surgery was less for penetrating trauma. Of the patients requiring open surgery for renal trauma within 24 hours of admission, nephrectomy is the most common surgery. Continued effort to reduce nephrectomy rates following abdominal trauma is necessary. Epidemiologic study, level III.