A new study finds that embolization greatly reduces the risk of acute kidney injury and in-hospital mortality compared to nephrectomy when treating initially stable trauma patients with high-grade kidney injuries. The study was published in the Journal of Vascular and Interventional Radiology (JVIR).
The analysis examined 849 cases of American Association for the Surgery of Trauma (AAST) grade III-V kidney injuries recorded in the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) national trauma patient registry between 2017 and 2022. Of those cases examined, 380 (44.8%) underwent nephrectomy and 469 (55.2%) underwent embolization.
Compared to embolization, nephrectomy was associated with a higher risk of in-hospital mortality (17.1% vs. 4.9%) and acute kidney injury (14.7% vs. 4.1%). In addition, nephrectomy was also associated with significantly higher rates of cardiac arrest with cardiopulmonary resuscitation (8.5% vs. 2.3%), unplanned return to the operating room (12.1% vs. 4%), severe sepsis (2.6% vs. 0.9%), myocardial infarction (1% vs. 0%), deep surgical site infection (1.5% vs. 0.2%) and superficial incisional surgical site infection (1.6% vs. 0.2%).
“Our findings show that embolization is safe, effective and associated with better outcomes than nephrectomy for this patient cohort in both the near- and long-term,” said Waseem Wahood, the paper’s lead author and an interventional radiology resident with the University of Miami Miller School of Medicine in Miami, USA.
“By reducing the risks of acute kidney injury, embolization may help avoid chronic illness for these patients,” Wahood said. “While additional prospective work is needed to validate these findings, our initial analysis demonstrates that a renal-preservation strategy with embolization should be considered for initial management of stable patients with high-grade renal trauma.”
