|
Citation
|
Dagenais J, Leow JJ, Haider AH, Wang Y, Chung BI, Chang SL, Eswara JR. Urology 2016; 97: 98-104. |
|
Abstract
|
OBJECTIVES: 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 non-urologists.
MATERIALS AND METHODS: Using the Premier Hospital database, we performed a retrospective study of all patients with renal trauma between 2003 and 2013. We identified patients using ICD9 diagnosis codes (866.0x, 866.1x), determined management strategy by ICD9 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.
RESULTS: 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 non-operative management from 65.2% in 2003 to 81.8% in 2013.
CONCLUSIONS: 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. While operative rates are decreasing, further consideration may need to be given to centralization of care to higher volume teaching hospitals to improve renal salvage.
Copyright © 2016. Published by Elsevier Inc.
Language: en |