Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fascia

dc.contributor.authorClements, Thomas W
dc.contributor.authorBall, Chad G
dc.contributor.authorNicol, Andrew J
dc.contributor.authorEdu, Sorin
dc.contributor.authorKirkpatrick, Andrew W
dc.contributor.authorNavsaria, Pradeep
dc.date.accessioned2022-09-14T16:11:38Z
dc.date.available2022-09-14T16:11:38Z
dc.date.issued2022-06-20
dc.date.updated2022-06-26T03:13:00Z
dc.description.abstractBackground Non-operative management has become increasingly popular in the treatment of renal trauma. While data are robust in blunt mechanisms, the role of non-operative management in penetrating trauma is less clear. Additionally, there is a paucity of data comparing gunshot and stab wounds. Methods A retrospective review of patients admitted to a high-volume level 1 trauma center (Groote Schuur Hospital, Cape Town) with penetrating abdominal trauma was performed. Patients with renal injuries were identified and compared based on mechanism [gunshot (GSW) vs. stab] and management strategy (operative vs. non-operative). Primary outcomes of interest were mortality and failure of non-operative management. Secondary outcomes of interest were nephrectomy rates, Clavien-Dindo complication rate, hospital length of stay, and overall morbidity rate. Results A total of 150 patients with renal injuries were identified (82 GSW, 68 stab). Overall, 55.2% of patients required emergent/urgent laparotomy. GSWs were more likely to cause grade V injury and concurrent intra-abdominal injuries (p > 0.05). The success rate of non-operative management was 91.6% (89.9% GSW, 92.8% stab, p = 0.64). The absence of hematuria on point of care testing demonstrated a negative predictive value of 98.4% (95% CI 96.8–99.2%). All but 1 patient who failed non-operative management had associated intra-abdominal injuries requiring surgical intervention. Opening of Gerota’s fascia resulted in nephrectomy in 55.6% of cases. There were no statistically significant risk factors for failure of non-operative management identified on univariate logistic regression. Conclusions NOM of penetrating renal injuries can be safely and effectively instituted in both gunshot and stab wounds with a very low number of patients progressing to laparotomy. Most patients fail NOM for associated injuries. During laparotomy, the opening of Gerota’s fascia may lead to increased risk of nephrectomy. Ongoing study with larger populations is required to develop effective predictive models of patients who will fail NOM.en_US
dc.identifier.apacitationClements, T. W., Ball, C. G., Nicol, A. J., Edu, S., Kirkpatrick, A. W., & Navsaria, P. (2022). Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fascia. <i>World Journal of Emergency Surgery</i>, 17(1), 35. http://hdl.handle.net/11427/36811en_ZA
dc.identifier.chicagocitationClements, Thomas W, Chad G Ball, Andrew J Nicol, Sorin Edu, Andrew W Kirkpatrick, and Pradeep Navsaria "Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fascia." <i>World Journal of Emergency Surgery</i> 17, 1. (2022): 35. http://hdl.handle.net/11427/36811en_ZA
dc.identifier.citationClements, T.W., Ball, C.G., Nicol, A.J., Edu, S., Kirkpatrick, A.W. & Navsaria, P. 2022. Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fascia. <i>World Journal of Emergency Surgery.</i> 17(1):35. http://hdl.handle.net/11427/36811en_ZA
dc.identifier.ris TY - Journal Article AU - Clements, Thomas W AU - Ball, Chad G AU - Nicol, Andrew J AU - Edu, Sorin AU - Kirkpatrick, Andrew W AU - Navsaria, Pradeep AB - Background Non-operative management has become increasingly popular in the treatment of renal trauma. While data are robust in blunt mechanisms, the role of non-operative management in penetrating trauma is less clear. Additionally, there is a paucity of data comparing gunshot and stab wounds. Methods A retrospective review of patients admitted to a high-volume level 1 trauma center (Groote Schuur Hospital, Cape Town) with penetrating abdominal trauma was performed. Patients with renal injuries were identified and compared based on mechanism [gunshot (GSW) vs. stab] and management strategy (operative vs. non-operative). Primary outcomes of interest were mortality and failure of non-operative management. Secondary outcomes of interest were nephrectomy rates, Clavien-Dindo complication rate, hospital length of stay, and overall morbidity rate. Results A total of 150 patients with renal injuries were identified (82 GSW, 68 stab). Overall, 55.2% of patients required emergent/urgent laparotomy. GSWs were more likely to cause grade V injury and concurrent intra-abdominal injuries (p > 0.05). The success rate of non-operative management was 91.6% (89.9% GSW, 92.8% stab, p = 0.64). The absence of hematuria on point of care testing demonstrated a negative predictive value of 98.4% (95% CI 96.8–99.2%). All but 1 patient who failed non-operative management had associated intra-abdominal injuries requiring surgical intervention. Opening of Gerota’s fascia resulted in nephrectomy in 55.6% of cases. There were no statistically significant risk factors for failure of non-operative management identified on univariate logistic regression. Conclusions NOM of penetrating renal injuries can be safely and effectively instituted in both gunshot and stab wounds with a very low number of patients progressing to laparotomy. Most patients fail NOM for associated injuries. During laparotomy, the opening of Gerota’s fascia may lead to increased risk of nephrectomy. Ongoing study with larger populations is required to develop effective predictive models of patients who will fail NOM. DA - 2022-06-20 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - World Journal of Emergency Surgery KW - Penetrating solid organ injury KW - Renal trauma KW - Non-operative management LK - https://open.uct.ac.za PY - 2022 T1 - Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fascia TI - Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fascia UR - http://hdl.handle.net/11427/36811 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s13017-022-00439-7
dc.identifier.urihttp://hdl.handle.net/11427/36811
dc.identifier.vancouvercitationClements TW, Ball CG, Nicol AJ, Edu S, Kirkpatrick AW, Navsaria P. Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fascia. World Journal of Emergency Surgery. 2022;17(1):35. http://hdl.handle.net/11427/36811.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Medicineen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceWorld Journal of Emergency Surgeryen_US
dc.source.journalissue1en_US
dc.source.journalvolume17en_US
dc.source.pagination35en_US
dc.subjectPenetrating solid organ injuryen_US
dc.subjectRenal traumaen_US
dc.subjectNon-operative managementen_US
dc.titlePenetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fasciaen_US
dc.typeJournal Articleen_US
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