Abstract: PD63-06
Sources of Funding: None

Introduction

Management of blunt renal trauma has evolved to favor a conservative approach. Penetrating trauma, however, has traditionally involved surgical intervention. The purpose of this study is to compare the trends in operative and nonoperative management following blunt and penetrating renal trauma.

Methods

A retrospective cross sectional analysis was performed using data from 2002-2012 within the National Trauma Data Bank (NTDB). Cases were identified by ICD-9 diagnosis codes. Codes 866.00 through 866.03 and 866.10 through 866.13 were queried for blunt and penetrating renal trauma, respectively. Only cases requiring interventions were included. Treatments were identified using ICD-9 procedure codes for nephrectomy (55.5x), renal laceration repair (55.81), arteriography (88.45) or endovascular repair (39.79).

Results

4296 cases were reported during the study period. Of these, 2635 involved blunt trauma and 1661 involved penetrating injury. Following blunt trauma, there was a significant increase in the percentage of cases managed by endovascular means (R2=0.92, p<0.01) with a corresponding decrease in the amount of patients undergoing both nephrectomy (R2=0.32, p=0.068) and laceration repair (R2=0.54, p<0.01) [Figure 1a]. Following penetrating trauma, there was also a significant decrease in nonoperative management (R2=0.69, p<0.01) largely explained by a decline in nephrectomy (###). Endovascular interventions significantly increased (R2=0.87, p<0.01) [Figure 1b]. These cases, however, were predominantly managed with laceration repair with no significant change over the study period.

Conclusions

Surgical intervention for blunt and penetrating trauma continues to decrease. Procedural intervention for blunt renal trauma largely consists of endovascular management. Although most interventions for penetrating trauma involve repair, nephrectomy has significantly decreased while endovascular management has increased. Future efforts should aim to characterize whether the current trends in surgical intervention following penetrating renal injuries is appropriate and if outcomes data warrants a change in guidelines that may allow for quality improvement and decreased morbidity.

Funding

None