title: Contemporary Trends in the Management of Renal Trauma in the United States: A National Community Hospital Population-based Analysis.
abstract: To better define the shift in the management of renal trauma throughout the United States, with a population-based assessment of community hospital practice patterns. To investigate how hospital, patient, and injury-specific factors influence management strategy by both urologists and nonurologists.
  
  
  
  Using the Premier Hospital database, we performed a retrospective study of all patients with renal trauma between 2003 and 2013. We identified patients using International Classification of Diseases, Ninth Revision diagnosis codes (866.0x, 866.1x), determined management strategy by International Classification of Diseases, Ninth Revision procedure codes, and dichotomized grouping by surgeon specialty. We stratified hospitals by annual renal trauma volume categorized a priori into low, <10 cases per year; intermediate, 10-20 cases per year; and high, >20 cases per year. We performed descriptive statistics and univariate and multivariate regression analyses adjusting for survey weighting and for patient, hospital, and injury-specific characteristics.
  
  
  
  Our study cohort included a weighted sample size of 21,531 patients. Higher renal trauma hospitals (12.6%) were significantly less likely than low (26.4%) and intermediate (31.3%) volume hospitals to undergo surgical intervention for renal trauma on adjusted models. There was a statistically significant increase in nonoperative management from 65.2% in 2003 to 81.8% in 2013.
  
  
  
  National rates of surgical intervention for renal trauma are significantly higher than those frequently quoted by the literature, especially among low- and intermediate-volume renal trauma hospitals. Although operative rates are decreasing, further consideration may need to be given to centralization of care in higher-volume teaching hospitals to improve renal salvage.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Julien
authors.initials: J
authors.lastname: Dagenais
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Leow
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ye
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Urology, Stanford University Medical Center, Stanford, CA.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Chung
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, MA. Electronic address: jeswara@partners.org.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Eswara
mesh_terms: D000328:Adult; D000529:Complementary Therapies / Q000379:methods / Q000639:trends*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014572:Urology / Q000592:standards / Q000639:trends*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*