Nephrectomy after High-Grade Renal Trauma is Associated with Higher Mortality: Results from the Multi-institutional Genitourinary Trauma Study (MiGUTS).
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 (HGRT) 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
RESULTS: A total of 1,181 HGRT patients were included. Median age was 31 and trauma mechanism was blunt in 78%. Injuries were graded 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
CONCLUSIONS: 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.
Online ahead of print
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; Primary Investigatorin conjunction with the Trauma and Urologic Reconstruction Network of Surgeons. Nephrectomy after High-Grade Renal Trauma is Associated with Higher Mortality: Results from the Multi-institutional Genitourinary Trauma Study (MiGUTS). Urology. 2021 Aug 23:S0090-4295(21)00777-9. doi: 10.1016/j.urology.2021.07.033. Epub ahead of print. PMID: 34437895.