Abstract
To compare rates of acute kidney injury and in-hospital mortality between embolization and nephrectomy in hemodynamically stable patients with American Association for the Surgery of Trauma(AAST) grade III-V blunt kidney injuries.
All cases of blunt AAST grade III-V kidney injuries from 2017-2022 were identified using the American College of Surgeons Trauma Quality Improvement Program database. Cases with initial hypotension(systolic blood pressure <90mm Hg), length of stay <24 hours, non-survivable injuries(any abbreviated injury score of 6), and transfers were excluded. Multivariable logistic regression was utilized to assess the effect of embolization on in-hospital mortality and acute kidney injury(AKI). Inverse propensity weighting with regression adjustment was used, adjusting for gender, hospital characteristics, vital signs, Glasgow Coma Scale, injury severity score and grade of kidney injury. Of 849 patients, 74.4% were male, median age was 37 years(interquartile range 24-57), and injury grade distribution was 15% grade III, 44% grade IV, and 41% grade V.
Of 849 cases of blunt AAST grade III-V kidney injuries, 469(55%) underwent embolization and 380(45%) underwent nephrectomy. On adjusted analysis, nephrectomy was associated with a 5.0% absolute increase in AKI(relative risk [RR] 2.22; p<0.001) and a 7.2% absolute increase in in-hospital mortality(RR 2.47; p<0.001) compared with embolization.
This study demonstrates that embolization is associated with both lower likelihood of AKI and mortality than nephrectomy in initially hemodynamically stable blunt trauma patients with high-grade kidney injuries. A kidney-preservation strategy with embolization may be considered for initial management of these patients, though future prospective work is needed to validate these findings.
•In hemodynamically stable patients with AAST grade III-V blunt kidney injuries, embolization was compared with nephrectomy using a national trauma databank cohort (2017-2022).•Nephrectomy was associated with more than a twofold higher risk of acute kidney injury and in-hospital mortality compared with embolization after inverse propensity weighting.•These findings support a kidney-sparing, catheter-based approach in appropriately selected stable patients with high-grade renal trauma.