PD31-04 NEPHRECTOMY IS NOT ASSOCIATED WITH INCREASED RISK OF MORTALITY OR ACUTE KIDNEY INJURY AFTER HIGH-GRADE RENAL TRAUMA: A PROPENSITY SCORE ANALYSIS OF THE TRAUMA QUALITY IMPROVEMENT PROGRAM (TQIP)

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-04 NEPHRECTOMY IS NOT ASSOCIATED WITH INCREASED RISK OF MORTALITY OR ACUTE KIDNEY INJURY AFTER HIGH-GRADE RENAL TRAUMA: A PROPENSITY SCORE ANALYSIS OF THE TRAUMA QUALITY IMPROVEMENT PROGRAM (TQIP) Benjamin McCormick, Joshua Horns, Rupam Das, Niraj Paudel, Heidi Hanson, and Jeremy Myers Benjamin McCormickBenjamin McCormick More articles by this author , Joshua HornsJoshua Horns More articles by this author , Rupam DasRupam Das More articles by this author , Niraj PaudelNiraj Paudel More articles by this author , Heidi HansonHeidi Hanson More articles by this author , and Jeremy MyersJeremy Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with high-grade renal trauma (HGRT) who undergo nephrectomy may be at higher risk for mortality compared to those who receive conservative management. However, no study has accounted for volume resuscitation with blood products as a confounder. We hypothesized that even when accounting for the amount of blood transfused, injury severity, and other patient factors, nephrectomy after HGRT would be associated with increased mortality and acute kidney injury (AKI). METHODS: We identified adult patients with HGRT (AAST grade III-V) in the American College of Surgeons TQIP database (2013-2017). Propensity scoring was used to adjust for the probability of nephrectomy. Patients undergoing nephrectomy were matched with replacement at a 1:5 ratio. Conditional logistic regression models with clustering were used (outcomes mortality and AKI). We adjusted for patient demographics, injury characteristics, shock, and units of packed red blood cells transfused in the first 24 hours. RESULTS: There were 14,470 patients included with HGRT, with 1,101 (7.6%) patients undergoing nephrectomy. Unadjusted mortality was 12.3% and 5.3% (p<0.001) in the nephrectomy and non-nephrectomy groups, respectively. In the nephrectomy patients, 7.9% experienced AKI during their hospital admission, compared to 2.2% of the non-nephrectomy patients (p<0.001). In our adjusted analysis, after propensity scoring and matching, there was no association between nephrectomy and higher mortality or AKI. In the adjusted analysis, increasing age, increasing injury severity score (ISS), decreasing Glasgow Coma Score (GCS), and higher volume of transfused blood were all associated with higher mortality. For AKI, independent predictors include increasing age, increasing ISS, penetrating injury, and blood transfusion. CONCLUSIONS: Using propensity scoring and adjusting for the volume of blood transfused in the first 24 hours, nephrectomy is not associated with increased mortality or AKI. This finding contradicts prior analyses where volume of blood was not accounted for. Despite these results, as a clinical principle, nephrectomy should be avoided when possible after HGRT. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e539-e539 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin McCormick More articles by this author Joshua Horns More articles by this author Rupam Das More articles by this author Niraj Paudel More articles by this author Heidi Hanson More articles by this author Jeremy Myers More articles by this author Expand All Advertisement Loading ...