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PD46-03 NEPHRECTOMY FOR HIGH-GRADE RENAL TRAUMA IS ASSOCIATED WITH HIGHER MORTALITY RATES

2020; Lippincott Williams & Wilkins; Volume: 203; Issue: Supplement 4 Linguagem: Inglês

10.1097/ju.0000000000000933.03

1527-3792

Sorena Keihani, Ross Anderson, Elisa Wang, Judith C. Hagedorn, Alexander P. Nocera, J. Patrick Selph, Chirag Arya, Rachel Sensenig, Michael E. Rezaee, Rachel A. Moses, James B. Mercer, Shubham Gupta, Clara M. Castillejo Becerra, Nima Baradaran, Katie Glavin, Joshua A. Broghammer, Richard A. Santucci, Frank Burks, Sean P. Elliott, Bradley A. Erickson, Benjamin N. Breyer, Bryan B. Voelzke, Raminder Nirula, Jeremy B. Myers,

Ureteral procedures and complications

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD46)1 Apr 2020PD46-03 NEPHRECTOMY FOR HIGH-GRADE RENAL TRAUMA IS ASSOCIATED WITH HIGHER MORTALITY RATES Sorena Keihani*, Ross Anderson, Elisa Wang, Judith Hagedorn, Alexander Nocera, J. Patrick Selph, Chirag Arya, Rachel Sensenig, Michael Rezaee, Rachel Moses, James Mercer, Shubham Gupta, Clara Castillejo Becerra, Nima Baradaran, Katie Glavin, Joshua Broghammer, Richard Santucci, Frank Burks, Sean Elliott, Bradley Erickson, Benjamin Breyer, Bryan Voelzke, Raminder Nirula, and Jeremy Myers Sorena Keihani*Sorena Keihani* More articles by this author , Ross AndersonRoss Anderson More articles by this author , Elisa WangElisa Wang More articles by this author , Judith HagedornJudith Hagedorn More articles by this author , Alexander NoceraAlexander Nocera More articles by this author , J. Patrick SelphJ. Patrick Selph More articles by this author , Chirag AryaChirag Arya More articles by this author , Rachel SensenigRachel Sensenig More articles by this author , Michael RezaeeMichael Rezaee More articles by this author , Rachel MosesRachel Moses More articles by this author , James MercerJames Mercer More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Clara Castillejo BecerraClara Castillejo Becerra More articles by this author , Nima BaradaranNima Baradaran More articles by this author , Katie GlavinKatie Glavin More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Richard SantucciRichard Santucci More articles by this author , Frank BurksFrank Burks More articles by this author , Sean ElliottSean Elliott More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Raminder NirulaRaminder Nirula More articles by this author , and Jeremy MyersJeremy Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000933.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephrectomy can be avoided in most patients even in cases of high-grade renal trauma (HGRT). The reasons for nephrectomy after trauma are complex but it is often done in hemodynamically unstable patients. However, the consequences of nephrectomy in acute trauma management are unknown. We hypothesized that undergoing nephrectomy would be associated with higher mortality rates after trauma. METHODS: We gathered data from 21 Level-1 trauma centers through phases 1 & 2 of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). Patients with HGRT (AAST grades III-V) were included. Data were gathered on demographics, injury characteristics, management, and outcomes. Descriptive statistics were used to compare patients who died and those who survived the injuries. Mixed-effect Poisson regression, with clustering by facility, was used to assess the association between nephrectomy and mortality in all patients and also in a subgroup of patients after excluding those who died within 24 hours of hospital arrival (early mortality group; n=53). Multivariable regression was performed to control for age, injury severity score (ISS), shock (systolic blood pressure <90mmHg at admission), and Glasgow Coma Scale (GCS). RESULTS: A total of 1,176 HGRT patients from MiGUTS phases 1 (n=431, 2014-2017) and 2 (n=745, 2013-2018) were included. Mean age was 36.2±16.8 and trauma mechanism was blunt in 78%. Injuries were AAST grade III, IV, and V in 55%, 35%, and 10%. There were 96 (8%) mortalities and 129 (11%) nephrectomies. Rate of 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 (Table). Nephrectomy was associated with a higher risk of death in both univariable (RR: 3.34; 95% CI: 2.15–5.19) and multivariable models (RR: 2.62, 95% CI: 1.61–4.24). Similar results were obtained after excluding the early mortality subgroup (RR: 3.30; 95% CI: 1.65–6.62). CONCLUSIONS: Nephrectomy is associated with higher mortality in the acute trauma setting even when controlling for shock, overall injury severity, and head injury. These results should be confirmed using larger databases controlling for multiple factors to find the potential causes behind this association. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e920-e920 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sorena Keihani* More articles by this author Ross Anderson More articles by this author Elisa Wang More articles by this author Judith Hagedorn More articles by this author Alexander Nocera More articles by this author J. Patrick Selph More articles by this author Chirag Arya More articles by this author Rachel Sensenig More articles by this author Michael Rezaee More articles by this author Rachel Moses More articles by this author James Mercer More articles by this author Shubham Gupta More articles by this author Clara Castillejo Becerra More articles by this author Nima Baradaran More articles by this author Katie Glavin More articles by this author Joshua Broghammer More articles by this author Richard Santucci More articles by this author Frank Burks More articles by this author Sean Elliott More articles by this author Bradley Erickson More articles by this author Benjamin Breyer More articles by this author Bryan Voelzke More articles by this author Raminder Nirula More articles by this author Jeremy Myers More articles by this author Expand All Advertisement PDF downloadLoading ...