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High-Grade Renal Trauma: Does Management Predict Length of Hospital Stay?

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High-Grade Renal Trauma: Does Management Predict Length of Hospital Stay?

Lindsay A Hampson, Anobel Y Odisho, Benjamin N Breyer, Jack W McAninch


•Management of high-grade renal trauma has shifted towards more non-operative management
•Analysis of length of hospital stay related to conservative versus operative management of renal trauma has not been studied
•Objective: describe the characteristics of patients with high-grade renal trauma by hospital stay and evaluate effect of conservative versus surgical management on length of hospital stay


•Cross-sectional retrospective analysis of a prospective contiguous database of individuals who sustained unilateral high-grade renal trauma at San Francisco General Hospital in San Francisco, CA fro 9/21/77 through 8/10/2012

•Patients’ injury mechanism, injury grade, and details about associated injuries and management were recorded by the urology provider
•Length of hospital stay was determined by admission and discharge dates


Statistical Analaysis

•Descriptive analysis was performed using chi-squared and linear regression
•Multivariate analysis was performed using a Fine-Gray model of competing risks survival analysis, adjusting for trauma type, grade, surgery, associated injury, and complications
•Discharge was defined as the event of interest
•Death was considered a competing event
•Interaction term for renal and non-GU surgery was included due to significant collinearity

Predictors of Length of Hospital Stay


In adjusted multivariate analysis, the following were significant predictors of increased length of hospital stay:


•Blunt trauma
•Grade 4 and 5 renal trauma (vs. grade 3)
•Undergoing non-renal surgery
•Having associated injuries
•Having a complication during hospitalization

Median hospital stay was shorter for for patients that did not not undergo renal exploration, although the difference between length of hospital stay for operative and conservative management was not found to be statistically significant


Future Directions


Further evaluation of how conservative versus surgical management of renal trauma may impact overall costs of trauma and hospitalization are necessary to understand the full health policy and economic implications of renal trauma management



These results suggest that conservative management of high-grade renal trauma does not extend patients’ length of hospitalization, and may even result in decreased length of hospital stay