The role of kidney-preserving surgery in renal trauma: A nationwide analysis.

Abstract

Although renal trauma is commonly managed nonoperatively, surgical intervention may be necessary in some patients. Within operative management, the rationale for choosing between total nephrectomy and kidney-preserving approaches remains unclear. In this study, we aimed to define the role of kidney-preserving surgery within renal trauma management. Using the National Trauma Data Bank 2017-2021, we retrospectively evaluated clinical characteristics and outcomes of patients who underwent total nephrectomy or kidney-preserving surgery. We performed logistic regression for the use of kidney-preserving surgery and to assess the risk of hospital complications between the 2 cohorts. Of 52,212 patients with renal injury, 1,756 (3.4%) and 794 (1.5%) underwent total nephrectomy and kidney-preserving surgery, respectively. Patients with penetrating injuries were more likely to undergo kidney-preserving surgery (odds ratio, 3.18; 95% confidence interval. 2.34-4.31, P < .001). Total nephrectomy was preferred for patients with admission systolic blood pressure <90 mm Hg (odds ratio, 0.61; 95% confidence interval, 0.47-0.79, P < .001), Glasgow Coma Scale <9 (odds ratio, 0.51; 95% confidence interval, 0.37-0.70, P < .001), or high-grade renal injuries (odds ratio, 0.41; 95% confidence interval, 0.33-0.52, P < .001). Kidney-preserving surgery was associated with a greater risk for postoperative urine leakage procedures (odds ratio, 1.40; 95% confidence interval, 1.06-1.85, P = .019) but a lower probability of requiring hemodialysis (odds ratio, 0.32; 95% confidence interval, 0.14-0.72, P = .006) or developing acute kidney injury (odds ratio, 0.49; 95% confidence interval, 0.32-0.76, P = .001). Kidney-preserving surgery is preferred for stable patients with penetrating trauma and lower-grade injuries. It carries a greater risk of requiring procedures for urine leakage but a decreased risk for acute kidney injury and the need for hemodialysis when compared to total nephrectomy.