Journal article
Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS)
Urology (Ridgewood, N.J.), Vol.157, pp.246-252
11/2021
DOI: 10.1016/j.urology.2021.07.033
PMID: 34437895
Abstract
To test the hypothesis that undergoing nephrectomy after high-grade renal trauma is associated with higher mortality rates.
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).
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).
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.
Details
- Title: Subtitle
- Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS)
- Creators
- S Mitchell Heiner - University of UtahSorena Keihani - University of UtahBenjamin J McCormick - University of UtahElisa Fang - †New York University Medical School, New York, NYJudith C Hagedorn - University of WashingtonBryan Voelzke - Spokane Urology, Spokane, WA.Alexander P Nocera - University of Alabama at BirminghamJ Patrick Selph - University of Alabama at BirminghamChirag S Arya - Cooper University HospitalRachel L Sensenig - Cooper University HospitalMichael E Rezaee - Dartmouth–Hitchcock Medical CenterRachel A Moses - Dartmouth–Hitchcock Medical CenterChristopher M Dodgion - Medical College of WisconsinMargaret M Higgins - University of KentuckyShubham Gupta - Case Western Reserve UniversityKaushik Mukherjee - Loma Linda University Medical CenterSarah Majercik - Intermountain Medical CenterBrian P Smith - Hospital of the University of PennsylvaniaKatie Glavin - University of Kansas Medical CenterJoshua A Broghammer - University of Kansas Medical CenterIan Schwartz - Hennepin County Medical CenterSean P Elliott - Hennepin County Medical CenterBenjamin N Breyer - University of California, San FranciscoClara M Castillejo Becerra - The Ohio State University Wexner Medical CenterNima Baradaran - The Ohio State University Wexner Medical CenterErik DeSoucy - University of California Davis Medical CenterScott Zakaluzny - University of California Davis Medical CenterBradley A Erickson - University of IowaBrandi D Miller - Detroit Medical CenterRichard A Santucci - The Crane Center for Transgender Surgery, Austin, TX.Reza Askari - Brigham and Women's HospitalMatthew M Carrick - Medical City Plano, Plano, TX.Frank N Burks - Oakland UniversityScott Norwood - The University of Texas Health Science Center at TylerRaminder Nirula - University of UtahJeremy B Myers - University of UtahTrauma and Urologic Reconstruction Network of Surgeons (TURNS)
- Resource Type
- Journal article
- Publication Details
- Urology (Ridgewood, N.J.), Vol.157, pp.246-252
- DOI
- 10.1016/j.urology.2021.07.033
- PMID
- 34437895
- ISSN
- 0090-4295
- eISSN
- 1527-9995
- Language
- English
- Date published
- 11/2021
- Academic Unit
- Urology
- Record Identifier
- 9984319987502771
Metrics
9 Record Views