MP29-14 OPERATIVE REPAIR OF BLUNT AND PENETRATING INJURIES TO THE BLADDER

Abstract

INTRODUCTION AND OBJECTIVE: External bladder trauma can be caused by blunt or penetrating injuries. Traditional dogma requires repair of intraperitoneal injuries; extraperitoneal injuries can be managed by catheter drainage unless complicated by associated injuries or associated exploratory surgery. METHODS: We examined patients >18 years old presenting with a bladder injury from 2007-2016 in the National Trauma Data Bank. Exclusions: patients with urethral, rectal or vaginal injury. Four separate groups were studied independently based on injury types: blunt intraperitoneal, blunt extraperitoneal, penetrating intraperitoneal and penetrating extraperitoneal injuries. Propensity score matching was performed within each study group between the repaired and non-repaired groups for: age, race, gender, year of presentation, insurance status, Charlson Comorbidity Index, presentation to an academic center, Injury Severity Score, concomitant abdominal surgeries, pelvic fracture status and concomitant intrabdominal organ injuries. Only patients with complete information were included. Logistic regression modeling was performed to evaluate for effect of bladder repair on in-hospital mortality while adjusting for the above-mentioned variables RESULTS: A total of 21,264 patients experienced bladder trauma between 2007-2016. Overall mortality rate for this population was 7.7%. Propensity score matching resulted in 4 injury groups, each with an equal number of patients undergoing operative and non-operative treatment: blunt intraperitoneal (n=703), blunt extraperitoneal (n=3712), penetrating intraperitoneal (n=2882), and penetrating extraperitoneal (n=1105). On logistic regression modeling, operative repair was associated with lower risk of mortality in each of the following groups: blunt and intraperitoneal (odds ratio-OR- 0.33; 95% confidence interval-CI-0.15 to 0.66, p=0.002), penetrating and intraperitoneal (OR = 0.24; 95% CI: 0.15-0.40, p<0.001), blunt and extraperitoneal (OR = 0.40; 95% CI: 0.33-0.50, p<0.001) CONCLUSIONS: Operative repair of blunt and penetrating intraperitoneal bladder injuries is associated with lower in-hospital mortality. Importantly, we found this strong protective association extends to repair of blunt extraperitoneal injuries as well. These findings are particularly noteworthy given that we controlled for associated exploratory surgery and excluded patients with the usual indications for operative repair of extraperitoneal bladder injury: associated urethral, rectal or vaginal injury Source of Funding: none