Predictors of nephrectomy in high-grade renal trauma patients treated primarily with conservative intent

Abstract

Background: For the majority of renal injuries, non-operative management is the standard of care with nephrectomy reserved for those with severe trauma. The aim of our study is to assess the characteristics of perinephric hematoma and other prognostic factors of surgical intervention for high-grade renal trauma independent of AAST OIS. Materials and methods: A total of 119 patients with high-grade renal trauma from January 2005 to September 2021 were identified for analysis. Hospital records and diagnostic imaging were reviewed to identify the need for surgical intervention, including total and partial nephrectomy. Factors examined include patient age, gender, ISS (Injury severity score), AAST-OIS, laceration location, length and number, perinephric hematoma characteristics, intravascular contrast extravasation, and devitalized segment status. Descriptive statistics and binary logistic regression were performed as appropriate. Results: The mean patient age was 31,39 and the mean ISS was 22,80. A total of 24 surgical interventions were required (20%) including partial and total nephrectomy. On univariate analysis, hypotension on admission, hematoma diameter, degree of devitalized fragment superior of 25%, and AAST OIS grade was associated with the need for surgical intervention. On multivariate analysis, only hypotension on admission (p: 0,029), hematoma diameter greater than 3,5 cm (p: 0,021), and AAST-OIS grade (p: 0,010 ) remained independently associated with surgical intervention. Conclusion: Perinephric hematoma size remains among prognostic factors for surgical intervention that allow better stratification of renal lesions and its study allows a better management of high-grade renal trauma.