Nephrectomy following trauma--impact on patient outcome

Area of Science:

• Trauma Surgery
• Nephrology
• Critical Care Medicine

Background:

• Nephrectomy for trauma is infrequently performed.
• Renal sparing procedures are often successful.
• The impact of nephrectomy on patient outcomes requires quantification.

Purpose of the Study:

• To evaluate the effects of nephrectomy on patient outcomes after trauma.
• To analyze the incidence of renal failure and sepsis following nephrectomy for trauma.
• To determine if nephrectomy is a major determinant of survival in trauma patients.

Main Methods:

• Retrospective review of trauma laparotomy cases over a 5-year period.
• Analysis of patients who underwent nephrectomy for renal trauma.
• Comparison of outcomes, including renal function, sepsis, and mortality, between patients with and without renal failure.

Main Results:

• 14 out of 783 trauma patients underwent nephrectomy, mostly for penetrating injuries.
• Associated injuries were common (average 3.6 per patient).
• Three patients exsanguinated intraoperatively. Four developed renal failure (three requiring hemodialysis), with onset 3 weeks post-surgery and preceded by sepsis.
• Two patients died from multiple organ failure.
• Surviving patients without renal failure had adequate renal function.

Conclusions:

• Renal failure following nephrectomy for trauma is a late complication, strongly associated with intra-abdominal sepsis.
• Nephrectomy indicates severe injury but is not the primary determinant of survival.
• Sepsis and multiple organ failure are the main causes of mortality in these patients.