Clinical outcomes of interventional radiology versus operative management in hemodynamically stable and unstable moderate-to-severe high-grade blunt renal trauma.

Abstract

Blunt renal trauma remains a major source of morbidity and mortality despite advances in non-operative management. This study evaluates clinical outcomes in adults with moderate-to-severe high-grade blunt renal trauma, comparing interventional radiology (IR) and operative management. This retrospective cohort study utilized the ACS-TQIP-PUF dataset (2017-2023) to evaluate outcomes in adult (≥18 years) trauma patients with moderate-to-severe (AIS abdomen ≥ 2, ISS ≥ 9) high-grade (AAST grade ≥4) blunt renal trauma who underwent operative management or IR approach. Patients were stratified by hemodynamic stability, initial hypertension, and trauma center level. Primary outcomes included mortality and nephrectomy rates. Secondary outcomes included transfusion requirements, nonoperative management failure, and complications. In hemodynamically stable adult trauma patients with moderate-to-severe blunt renal injuries, IR was associated with lower 24-hour (aOR 0.477, 95% CI 0.274-0.83, p = 0.009) and in-hospital mortality (aOR 0.210, 95% CI 0.116-0.378, p < 0.001). Among unstable patients, IR was associated with reduced in-hospital mortality (aOR 0.076, CI: 0.007-0.847, p = 0.036). IR was also associated with reduced in-hospital mortality when stratifying by presence of initial hypertension (aOR 0.317, 95% CI:0.103-0.973, p = 0.045) and trauma center level, specifically at level I centers (24-hour mortality: aOR 0.047, CI:0.006-0.370, p = 0.004; in-hospital mortality: aOR 0.135, CI: 0.042-0.435, p < 0.001). Overall, no significant difference in odds of complications were observed. IR intervention was determined to be a safe and effective management approach for adult trauma patients with moderate-to-severe high-grade blunt renal injuries regardless of hemodynamic stability, initial hypertension, or trauma center level.