Management and hospital outcomes of blunt renal artery injuries: analysis of 517 patients from the National Trauma Data Bank.
BACKGROUND
Blunt renal artery injuries are rare and no single trauma center can accumulate substantial experience for meaningful conclusions about optimal therapeutic strategies. The purpose of this study was to assess the incidence of renal artery injuries after different types of blunt trauma, and evaluate the current therapeutic approaches practiced by American trauma surgeons and the effect of various therapeutic modalities on hospital outcomes.


METHODS
This was a National Trauma Data Bank study including all blunt trauma admissions with renal artery injuries. Demographics, mechanism of injury, Injury Severity Score, Abbreviated Injury Score for each body area (head, chest, abdomen, extremities) injuries, type of management (nephrectomy, arterial reconstruction, or observation), time from admission to definitive treatment, and hospital outcomes (mortality, ICU, and hospital stay) were analyzed. Multiple and logistic regression analyses were used to examine the relationship between type of management and hospital outcomes.


RESULTS
Of a total of 945,326 blunt trauma admissions, 517 patients (0.05%) had injuries to the renal artery. Of the 517 patients, the kidney was not explored in 376 (73%), 95 (18%) patients had immediate nephrectomy, and 45 (9%) patients underwent surgical revascularization. In 87 of 517 (17%) patients, renal artery injury was the only intraabdominal injury. Of the 87 patients with isolated renal artery injuries, 73 (84%) were observed, 7 (8%) underwent surgical revascularization, and 7 (8%) had early nephrectomy. Multiple regression analysis demonstrated that patients who had surgical revascularization had a considerably longer ICU and hospital stay than observed patients. Patients who had nephrectomy had a considerably longer hospital stay than observed patients.


CONCLUSIONS
Blunt renal artery injury is rare. Nonoperative management should be considered as an acceptable therapeutic option.
Sangthong
Burapat
B
Division of Trauma and Critical Care, Department of Surgery, School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Demetriades
Demetrios
D
Martin
Matthew
M
Salim
Ali
A
Brown
Carlos
C
Inaba
Kenji
K
Rhee
Peter
P
Chan
Linda
L
D000007:Abdominal Injuries / Q000453:epidemiology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D019992:Databases as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000706:statistics & numerical data; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012077:Renal Artery / Q000293:injuries* / Q000601:surgery; D015607:Stents; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology* / Q000601:surgery