Contemporary management and outcomes of penetrating traumatic AAST-OIS grade III and IV kidney injuries undergoing laparotomy: a Trauma Quality Improvement Program analysis

Authors

• Micaela Gomez, Department of Vascular Surgery, Wake Forest University, Winston-Salem, NC, USA.
• Maximilian Peter Forssten, Department of Orthopedic Surgery, Västmanland Hospital Västerås, Västerås, Sweden.
• Lucas P. Neff, Department of Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
• Lovisa Ekestubbe, Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
• Yousef AlHussaini, Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait.
• Babak Sarani, Center of Trauma and Critical Care, George Washington University, Washington, DC, USA.
• Shahin Mohseni, School of Medical Sciences, Örebro University, Örebro, Sweden. [email protected].

Document Type

Journal Article

Publication Date

4-25-2026

Journal

Scientific reports

DOI

10.1038/s41598-026-47007-6

Keywords

Kidney; Nephrectomy; Penetrating wounds; Renal salvage

Abstract

This study aimed to compare the outcomes of renal salvage (no nephrectomy) to nephrectomy patients with a penetrating American Association for the Surgery of Trauma-Organ Injury Scale grade III or IV kidney injury. The 2013-2021 Trauma Quality Improvement Program dataset was queried for patients with a penetrating grade III or IV kidney injury who underwent laparotomy within 24 h of admission. The association between nephrectomy and binary outcomes was investigated using Poisson regression models, with results presented as a prevalence ratio (PR) and corresponding 95% confidence interval (CI). A total of 2,214 grade III and 2,669 grade IV kidney injuries were identified. 89% of grade III injuries and 54% of grade IV injuries were managed without nephrectomy. After adjustment for confounding, nephrectomy in patients with a grade III penetrating kidney injury was associated with an increased risk of mortality [adjusted PR (95% CI): 1.53 (1.06-2.20), p = 0.023], complications [adjusted PR (95% CI): 1.25 (1.05-1.48), p = 0.010], post-complication mortality [adjusted PR (95% CI): 1.80 (1.09-2.96), p = 0.022], and ICU admission [adjusted PR (95% CI): 1.05 (1.00-1.11), p = 0.046], compared to renal salvage. In patients with a grade IV penetrating kidney injury, nephrectomy was only associated with an increased risk of ICU admission [adjusted PR (95% CI): 1.06 (1.02-1.09), p = 0.001], compared to renal salvage. Consequently, in patients with a grade III penetrating kidney injury, nephrectomy was associated with an increased risk of adverse outcomes. Among patients with a grade IV injury, nephrectomy was associated only with an increased risk of ICU admission. However, given the potential for residual confounding, these findings should be interpreted with caution.

APA Citation

Gomez, Micaela; Forssten, Maximilian Peter; Neff, Lucas P.; Ekestubbe, Lovisa; AlHussaini, Yousef; Sarani, Babak; and Mohseni, Shahin, "Contemporary management and outcomes of penetrating traumatic AAST-OIS grade III and IV kidney injuries undergoing laparotomy: a Trauma Quality Improvement Program analysis" (2026). GW Authored Works. Paper 9016.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/9016

Department

Surgery