Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis
Andrea Mingoli,1,2 Marco La Torre,1,2 Emanuele Migliori,1,2 Bruno Cirillo,1,2 Martina Zambon,1,2 Paolo Sapienza,1,2 Gioia Brachini1,2 1Emergency Department, 2Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy Introduction: Preservation of kidney and renal func...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2017-08-01
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| Series: | Therapeutics and Clinical Risk Management |
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| Online Access: | https://www.dovepress.com/operative-and-nonoperative-management-for-renal-trauma-comparison-of-o-peer-reviewed-article-TCRM |
| _version_ | 1819032583894204416 |
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| author | Mingoli A La Torre M Migliori E Cirillo B Zambon M Sapienza P Brachini G |
| author_facet | Mingoli A La Torre M Migliori E Cirillo B Zambon M Sapienza P Brachini G |
| author_sort | Mingoli A |
| collection | DOAJ |
| description | Andrea Mingoli,1,2 Marco La Torre,1,2 Emanuele Migliori,1,2 Bruno Cirillo,1,2 Martina Zambon,1,2 Paolo Sapienza,1,2 Gioia Brachini1,2 1Emergency Department, 2Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy Introduction: Preservation of kidney and renal function is the goal of nonoperative management (NOM) of renal trauma (RT). The advantages of NOM for minor blunt RT have already been clearly described, but its value for major blunt and penetrating RT is still under debate. We present a systematic review and meta-analysis on NOM for RT, which was compared with the operative management (OM) with respect to mortality, morbidity, and length of hospital stay (LOS). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed for this study. A systematic search was performed on Embase, Medline, Cochrane, and PubMed for studies published up to December 2015, without language restrictions, which compared NOM versus OM for renal injuries. Results: Twenty nonrandomized retrospective cohort studies comprising 13,824 patients with blunt (2,998) or penetrating (10,826) RT were identified. When all RT were considered (American Association for the Surgery of Trauma grades 1–5), NOM was associated with lower mortality and morbidity rates compared to OM (8.3% vs 17.1%, odds ratio [OR] 0.471; 95% confidence interval [CI] 0.404–0.548; P<0.001 and 2% vs 53.3%, OR 0.0484; 95% CI 0.0279–0.0839, P<0.001). Likewise, NOM represented the gold standard treatment resulting in a lower mortality rate compared to OM even when only high-grade RT was considered (9.1% vs 17.9%, OR 0.332; 95% CI 0.155–0.708; P=0.004), be they blunt (4.1% vs 8.1%, OR 0.275; 95% CI 0.0957–0.788; P=0.016) or penetrating (9.1% vs 18.1%, OR 0.468; 95% CI 0.398–0.0552; P<0.001). Conclusion: Our meta-analysis demonstrated that NOM for RT is the treatment of choice not only for AAST grades 1 and 2, but also for higher grade blunt and penetrating RT. Keywords: renal trauma, blunt trauma, penetrating trauma, operative management, nonoperative management, systematic review, meta-analysis |
| first_indexed | 2024-12-21T07:04:15Z |
| format | Article |
| id | doaj.art-3a11f69e2dec40b6aa65344f148d8366 |
| institution | Directory Open Access Journal |
| issn | 1178-203X |
| language | English |
| last_indexed | 2024-12-21T07:04:15Z |
| publishDate | 2017-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Therapeutics and Clinical Risk Management |
| spelling | doaj.art-3a11f69e2dec40b6aa65344f148d83662022-12-21T19:12:09ZengDove Medical PressTherapeutics and Clinical Risk Management1178-203X2017-08-01Volume 131127113834522Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysisMingoli ALa Torre MMigliori ECirillo BZambon MSapienza PBrachini GAndrea Mingoli,1,2 Marco La Torre,1,2 Emanuele Migliori,1,2 Bruno Cirillo,1,2 Martina Zambon,1,2 Paolo Sapienza,1,2 Gioia Brachini1,2 1Emergency Department, 2Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy Introduction: Preservation of kidney and renal function is the goal of nonoperative management (NOM) of renal trauma (RT). The advantages of NOM for minor blunt RT have already been clearly described, but its value for major blunt and penetrating RT is still under debate. We present a systematic review and meta-analysis on NOM for RT, which was compared with the operative management (OM) with respect to mortality, morbidity, and length of hospital stay (LOS). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed for this study. A systematic search was performed on Embase, Medline, Cochrane, and PubMed for studies published up to December 2015, without language restrictions, which compared NOM versus OM for renal injuries. Results: Twenty nonrandomized retrospective cohort studies comprising 13,824 patients with blunt (2,998) or penetrating (10,826) RT were identified. When all RT were considered (American Association for the Surgery of Trauma grades 1–5), NOM was associated with lower mortality and morbidity rates compared to OM (8.3% vs 17.1%, odds ratio [OR] 0.471; 95% confidence interval [CI] 0.404–0.548; P<0.001 and 2% vs 53.3%, OR 0.0484; 95% CI 0.0279–0.0839, P<0.001). Likewise, NOM represented the gold standard treatment resulting in a lower mortality rate compared to OM even when only high-grade RT was considered (9.1% vs 17.9%, OR 0.332; 95% CI 0.155–0.708; P=0.004), be they blunt (4.1% vs 8.1%, OR 0.275; 95% CI 0.0957–0.788; P=0.016) or penetrating (9.1% vs 18.1%, OR 0.468; 95% CI 0.398–0.0552; P<0.001). Conclusion: Our meta-analysis demonstrated that NOM for RT is the treatment of choice not only for AAST grades 1 and 2, but also for higher grade blunt and penetrating RT. Keywords: renal trauma, blunt trauma, penetrating trauma, operative management, nonoperative management, systematic review, meta-analysishttps://www.dovepress.com/operative-and-nonoperative-management-for-renal-trauma-comparison-of-o-peer-reviewed-article-TCRMRenal trauma Blunt trauma Penetrating trauma Operative management Non-operative management Systematic review Meta-analysis |
| spellingShingle | Mingoli A La Torre M Migliori E Cirillo B Zambon M Sapienza P Brachini G Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis Therapeutics and Clinical Risk Management Renal trauma Blunt trauma Penetrating trauma Operative management Non-operative management Systematic review Meta-analysis |
| title | Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis |
| title_full | Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis |
| title_fullStr | Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis |
| title_full_unstemmed | Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis |
| title_short | Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis |
| title_sort | operative and nonoperative management for renal trauma comparison of outcomes a systematic review and meta analysis |
| topic | Renal trauma Blunt trauma Penetrating trauma Operative management Non-operative management Systematic review Meta-analysis |
| url | https://www.dovepress.com/operative-and-nonoperative-management-for-renal-trauma-comparison-of-o-peer-reviewed-article-TCRM |
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