Faculty Collaboration Database

Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS). Urology 2021 Nov;157:246-252

Date

08/27/2021

Pubmed ID

34437895

DOI

10.1016/j.urology.2021.07.033

Scopus ID

2-s2.0-85116323497 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

OBJECTIVE: To test the hypothesis that undergoing nephrectomy after high-grade renal trauma is associated with higher mortality rates.

METHODS: We gathered data from 21 Level-1 trauma centers through the Multi-institutional Genito-Urinary Trauma Study. Patients with high-grade renal trauma were included. We assessed the association between nephrectomy and mortality in all patients and in subgroups of patients after excluding those who died within 24 hours of hospital arrival and those with GCS≤8. We controlled for age, injury severity score (ISS), shock (systolic blood pressure <90 mmHg), and Glasgow Coma Scale (GCS).

RESULTS: A total of 1181 high-grade renal trauma patients were included. Median age was 31 and trauma mechanism was blunt in 78%. Injuries were graded as III, IV, and V in 55%, 34%, and 11%, respectively. There were 96 (8%) mortalities and 129 (11%) nephrectomies. Mortality was higher in the nephrectomy group (21.7% vs 6.5%, P <.001). Those who died were older, had higher ISS, lower GCS, and higher rates of shock. After adjusting for patient and injury characteristics nephrectomy was still associated with higher risk of death (RR: 2.12, 95% CI: 1.26-2.55).

CONCLUSION: Nephrectomy was associated with higher mortality in the acute trauma setting even when controlling for shock, overall injury severity, and head injury. These results may have implications in decision making in acute trauma management for patients not in extremis from renal hemorrhage.

Author List

Heiner SM, Keihani S, McCormick BJ, Fang E, Hagedorn JC, Voelzke B, Nocera AP, Selph JP, Arya CS, Sensenig RL, Rezaee ME, Moses RA, Dodgion CM, Higgins MM, Gupta S, Mukherjee K, Majercik S, Smith BP, Glavin K, Broghammer JA, Schwartz I, Elliott SP, Breyer BN, Becerra CMC, Baradaran N, DeSoucy E, Zakaluzny S, Erickson BA, Miller BD, Santucci RA, Askari R, Carrick MM, Burks FN, Norwood S, Nirula R, Myers JB, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Female
Humans
Injury Severity Score
Kidney
Male
Middle Aged
Nephrectomy
Retrospective Studies
Wounds and Injuries
Young Adult