Nephrectomy after High-Grade Renal Trauma is Associated with Higher Mortality: Results from the Multi-institutional Genitourinary Trauma Study (MiGUTS).

Abstract

OBJECTIVE\nTo test the hypothesis that undergoing nephrectomy after high-grade renal trauma is associated with higher mortality rates.\n\n\nMETHODS\nWe 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 <90mmHg), and Glasgow Coma Scale (GCS).\n\n\nRESULTS\nA 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<0.001). 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).\n\n\nCONCLUSIONS\nNephrectomy 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.