PD31-02 UROLOGIC CONSULTATION IMPROVES RENAL SALVAGE RATES AT A REGIONAL LEVEL 1 TRAUMA CENTER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-02 UROLOGIC CONSULTATION IMPROVES RENAL SALVAGE RATES AT A REGIONAL LEVEL 1 TRAUMA CENTER Joseph Kim, Nicholas Ottaiano, Francisco Brito, Bradley Spieler, Crawford Dixon, Eric Wallace, Christopher Koller, William Hughes, Steven Brandes, Juan Duchesne, Chrissy Guidry, Omer Raheem, and Cooper Benson Joseph KimJoseph Kim More articles by this author , Nicholas OttaianoNicholas Ottaiano More articles by this author , Francisco BritoFrancisco Brito More articles by this author , Bradley SpielerBradley Spieler More articles by this author , Crawford DixonCrawford Dixon More articles by this author , Eric WallaceEric Wallace More articles by this author , Christopher KollerChristopher Koller More articles by this author , William HughesWilliam Hughes More articles by this author , Steven BrandesSteven Brandes More articles by this author , Juan DuchesneJuan Duchesne More articles by this author , Chrissy GuidryChrissy Guidry More articles by this author , Omer RaheemOmer Raheem More articles by this author , and Cooper BensonCooper Benson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of traumatic renal injury has evolved over time, with increasing recognition that a majority of renal injuries can be safely managed conservatively. Although the kidneys are the most commonly injured genitourinary organ, active Urologic consultation for these injuries is highly variable across institutions. We hypothesize that urologic consultation will improve outcomes for patients with renal trauma. METHODS: A retrospective analysis of an IRB approved Trauma Registry was queried for all patients sustaining renal trauma, between 2012-2019. We collected baseline demographics, injury characteristics, and details on hospital course on patients sustaining Blunt Injury (BI) or Penetrating Injury (PI). Renal injuries were classified according to the AAST grading system, and expert radiologic review of CT scans was done to classify AAST grade and further characterize radiologic injury patterns. Primary outcome measures were differences in rates of nephrectomy or mortality with urology consult. Logistic regression analysis was performed using R statistical software with significance defined as (p<0.05). RESULTS: A total of 441 patients were admitted for renal trauma. Urology was consulted for a minority of cases, 76 patients (17.0%) over the study period. Among patients being co-managed, Urology performed interventions for the treatment of 17 patients (3.9%) that included 4 pyelograms, 3 ureteral stents, 3 pyelograms with stents, 3 renorrhaphies, 2 nephrectomies, and 2 renal vascular repairs. High grade renal injury (AAST 4&5) was associated with increased odds of urology being consulted (OR 2.5, p = 0.0024). Urology consultation was associated with a significantly lower odds of nephrectomy compared to those patients managed by Trauma Surgery (OR 0.19, p=0.0060). Urology consultation was associated with lower overall mortality (OR 0.11, p=0.027) regardless of injury type. In the setting of high-grade PI trauma, urologic consultation was associated with 15 times higher renal salvage rates, (OR 0.068 for nephrectomy, p=0.016). CONCLUSIONS: We found an overall low incidence of urology consultation at our trauma center. Despite this, in cases where urology was actively involved there were lower odds of nephrectomy and mortality. In the setting of high-grade PI, urologic consultation resulted significantly higher odds of renal salvage. Urology consultation and multidisciplinary collaboration should be encouraged and may provide an opportunity to improve patient outcomes. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e538-e539 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Kim More articles by this author Nicholas Ottaiano More articles by this author Francisco Brito More articles by this author Bradley Spieler More articles by this author Crawford Dixon More articles by this author Eric Wallace More articles by this author Christopher Koller More articles by this author William Hughes More articles by this author Steven Brandes More articles by this author Juan Duchesne More articles by this author Chrissy Guidry More articles by this author Omer Raheem More articles by this author Cooper Benson More articles by this author Expand All Advertisement Loading ...