Trends of incidence, management and outcome of renal trauma in Germany (2008-2022): an analysis based on the TraumaRegister DGU®.

BACKGROUND AND

OBJECTIVE

In prior times surgical treatment was the standard treatment of severe renal injuries while nowadays there is an increasing favor of conservative or interventional treatment.

METHODS

Data retrieved from the TraumaRegister DGU® included 138,447 trauma patients (Max. AIS ≥ 3) in Germany from 2008 to 2022.

KEY FINDINGS: The incidence of kidney trauma decreased from 3.8% in 2008 to 2.7% in 2022 (p < 0.001). Higher grades of renal injury were associated with increased risks of kidney and multiorgan failure (AAST II: 29.0%; AAST V: 51.5%), dialysis (AAST II: 5%; AAST V: 18.9%), sepsis (AAST II: 9.2%; AAST V: 15.8%) and in-hospital mortality (AAST II: 9.4%; AAST V: 32.8%). The rate of surgical treatment remained constant with about 20%. The strongest predictor for operative treatment was AAST severity (reference: AAST grade II): Odds ratio for grade III was 4.50 (95% confidence interval 3.63-5.58, for grade IV 24.6 (19.1-31.8), and for grade V 58.9 (39.7-87.4). Further predictive factors were other abdominal injuries and the need for blood transfusions. Partial or radical nephrectomy was predominantly performed in high-grade renal injuries, with 62.1% (n = 36) in AAST V and 25.0% (n = 26) in other high-grade traumas. Interventional bleeding control was most frequent in AAST III (21.7%, n = 13) and AAST IV (19.2%, n = 20).

CONCLUSION

Although the incidence of renal injuries has slightly declined, the rate of surgical interventions remains unchanged. Factors favoring surgery included hemodynamic instability and further abdominal trauma. Nephrectomies were mainly performed in high-grade renal trauma, while interventional bleeding control was more frequent in lower AAST grades.