Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS) - 09/12/21

Doi : 10.1016/j.urology.2021.07.033

S. Mitchell Heiner ¹, Sorena Keihani ^1,^⁎ , Benjamin J. McCormick ¹, Elisa Fang ², Judith C. Hagedorn ³, Bryan Voelzke ⁴, Alexander P. Nocera ⁵, J. Patrick Selph ⁵, Chirag S. Arya ⁶, Rachel L. Sensenig ⁶, Michael E. Rezaee ⁷, Rachel A. Moses ⁷, Christopher M. Dodgion ⁸, Margaret M. Higgins ⁹, Shubham Gupta ¹⁰, Kaushik Mukherjee ¹¹, Sarah Majercik ¹², Brian P. Smith ¹³, Katie Glavin ¹⁴, Joshua A. Broghammer ¹⁴, Ian Schwartz ¹⁵, Sean P. Elliott ¹⁵, Benjamin N. Breyer ¹⁶, Clara M. Castillejo Becerra ¹⁷, Nima Baradaran ¹⁷, Erik DeSoucy ¹⁸, Scott Zakaluzny ¹⁸, Bradley A. Erickson ¹⁹, Brandi D. Miller ²⁰, Richard A. Santucci ²¹, Reza Askari ²², Matthew M. Carrick ²³, Frank N. Burks ²⁴, Scott Norwood ²⁵, Raminder Nirula ¹, Jeremy B. Myers ¹
in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons
¹ Department of Surgery, University of Utah, Salt Lake City, UT
² New York University Medical School, New York, NY
³ Department of Urology, University of Washington, Seattle, WA
⁴ Spokane Urology, Spokane, WA
⁵ Department of Urology, University of Alabama at Birmingham, Birmingham, AL
⁶ Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ
⁷ Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
⁸ Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
⁹ Department of Urology, University of Kentucky, Lexington, KY
¹⁰ Department of Urology, Case Western Reserve University, Cleveland, OH
¹¹ Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA
¹² Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT
¹³ Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
¹⁴ University of Kansas Medical Center, Kansas City, KS
¹⁵ Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
¹⁶ Department of Urology, University of California, San Francisco, CA
¹⁷ Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
¹⁸ Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA
¹⁹ Department of Urology, University of Iowa, Iowa City, IA
²⁰ Department of Urology, Detroit Medical Center, Detroit, MI
²¹ The Crane Center for Transgender Surgery, Austin, TX
²² Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA
²³ Medical City Plano, Plano, TX
²⁴ Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI
²⁵ Department of Surgery, UT Health Tyler, Tyler, TX

^⁎Address correspondence to: Sorena Keihani, M.D., M.S.C.I., Division of Urology, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132.Division of Urology, Department of SurgeryUniversity of Utah School of Medicine30 North 1900 EastSalt Lake CityUT84132

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.

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