Impact of Hospital Volume on the Outcomes of Renal Trauma Management

doi:10.1016/j.euros.2022.01.004

. 2022 Feb 8:37:99-105.

doi: 10.1016/j.euros.2022.01.004. eCollection 2022 Mar.

Impact of Hospital Volume on the Outcomes of Renal Trauma Management

Paul Baloche¹, Nicolas Szabla¹, Lucas Freton², Marine Hutin³, Marina Ruggiero⁴, Ines Dominique⁵, Clementine Millet⁶, Sebastien Bergerat⁷, Paul Panayotopoulos⁸, Reem Betari⁹, Xavier Matillon⁵, Ala Chebbi¹⁰, Thomas Caes¹¹, Pierre-Marie Patard¹², Nicolas Brichart¹³, Laura Sabourin⁶, Charles Dariane¹⁴, Michael Baboudjian¹⁵, Bastien Gondran-Tellier¹⁵, Cedric Lebacle⁴, François-Xavier Madec¹⁵, François-Xavier Nouhaud¹⁰, Xavier Rod¹⁵, Gaelle Fiard¹⁶, Benjamin Pradere¹⁷, Benoit Peyronnet²

Affiliations

¹ Department of Urology, University of Caen, Caen, France.
² Department of Urology, University of Rennes, Rennes, France.
³ Department of Urology, University of Montpellier, Montpellier, France.
⁴ Department of Urology, CHU Bicêtre, University of Paris Sud, Paris, France.
⁵ Department of Urology, University of Lyon, Lyon, France.
⁶ Department of Urology, University of Clermont-Ferrand, Clermont-Ferrand, France.
⁷ Department of Urology, University of Strasbourg, Strasbourg, France.
⁸ Department of Urology, University of Angers, Angers, France.
⁹ Department of Urology, University of Amiens, Amiens, France.
¹⁰ Department of Urology, University of Rouen, Rouen, France.
¹¹ Department of Urology, University of Lille, Lille, France.
¹² Department of Urology, University of Toulouse, Toulouse, France.
¹³ Department of Urology, University of Orléans, Orléans, France.
¹⁴ Department of Urology, University of Paris Descartes, Paris, France.
¹⁵ Department of Urology, University of Nantes, Nantes, France.
¹⁶ Department of Urology, University of Grenoble, Grenoble, France.
¹⁷ Department of Urology, University of Tours, Tours, France.

PMID: 35243394
PMCID: PMC8883196
DOI: 10.1016/j.euros.2022.01.004

Impact of Hospital Volume on the Outcomes of Renal Trauma Management

Paul Baloche et al. Eur Urol Open Sci. 2022.

. 2022 Feb 8:37:99-105.

doi: 10.1016/j.euros.2022.01.004. eCollection 2022 Mar.

Authors

Affiliations

¹ Department of Urology, University of Caen, Caen, France.
² Department of Urology, University of Rennes, Rennes, France.
³ Department of Urology, University of Montpellier, Montpellier, France.
⁴ Department of Urology, CHU Bicêtre, University of Paris Sud, Paris, France.
⁵ Department of Urology, University of Lyon, Lyon, France.
⁶ Department of Urology, University of Clermont-Ferrand, Clermont-Ferrand, France.
⁷ Department of Urology, University of Strasbourg, Strasbourg, France.
⁸ Department of Urology, University of Angers, Angers, France.
⁹ Department of Urology, University of Amiens, Amiens, France.
¹⁰ Department of Urology, University of Rouen, Rouen, France.
¹¹ Department of Urology, University of Lille, Lille, France.
¹² Department of Urology, University of Toulouse, Toulouse, France.
¹³ Department of Urology, University of Orléans, Orléans, France.
¹⁴ Department of Urology, University of Paris Descartes, Paris, France.
¹⁵ Department of Urology, University of Nantes, Nantes, France.
¹⁶ Department of Urology, University of Grenoble, Grenoble, France.
¹⁷ Department of Urology, University of Tours, Tours, France.

PMID: 35243394
PMCID: PMC8883196
DOI: 10.1016/j.euros.2022.01.004

Abstract

Background: Some health care systems have set up referral trauma centers to centralize expertise to improve trauma management. There is scant and controversial evidence regarding the impact of provider's volume on the outcomes of trauma management.

Objective: To evaluate the impact of hospital volume on the outcomes of renal trauma management in a European health care system.

Design setting and participants: A retrospective multicenter study, including all patients admitted for renal trauma in 17 French hospitals between 2005 and 2015, was conducted.

Intervention: Nephrectomy, angioembolization, or nonoperative management.

Outcome measurements and statistical analysis: Four quartiles according to the caseload per year: low volume (eight or fewer per year), moderate volume (nine to 13 per year), high volume (14-25/yr), and very high volume (≥26/yr). The primary endpoint was failure of nonoperative management defined as any interventional radiology or surgical procedure needed within the first 30 d after admission.

Results and limitations: Of 1771 patients with renal trauma, 1704 were included. Nonoperative management was more prevalent in the very-high- and low-volume centers (p = 0.02). In a univariate analysis, very high hospital volume was associated with a lower risk of nonoperative management failure than low (odds ratio [OR] = 0.54; p = 0.05) and moderate (OR = 0.48; p = 0.02) hospital volume. There were fewer nephrectomies in the high- and very-high-volume groups (p = 0.003). In a multivariate analysis, very high volume remained associated with a lower risk of nonoperative management failure than low (OR = 0.48; p = 0.04) and moderate (OR = 0.42; p = 0.01) volume. Study limitations include all the shortcomings inherent to its retrospective multicenter design.

Conclusions: In this multicenter study, management of renal trauma varied according to hospital volume. There were lower rates of nephrectomy and failure of nonoperative management in very-high-volume centers. These results raise the question of centralizing the management of renal trauma, which is currently not the case in our health care system.

Patient summary: In this study, management of renal trauma varied according to hospital volume. Very-high-volume centers had lower rates of nephrectomy and failure of nonoperative management.

Keywords: Centralization; Complication; Hospital volume; Outcomes; Renal trauma.

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References

1. Santucci R.A., Wessells H., Bartsch G., et al. Evaluation and management of renal injuries: consensus statement of the Renal Trauma Subcommittee: Renal Trauma Consensus statement. BJU Int. 2004;93:937–954. - PubMed
1. Sujenthiran A., Elshout P.J., Veskimae E., et al. Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review. Eur Urol Focus. 2019;5:290–300. - PubMed
1. Peyronnet B., Mathieu R., Couapel J.-P., Verhoest G., Bensalah K. Traumatismes fermés du rein et de l’uretère. EMC Urol. 2012;5:1–10.
1. Bryk D.J., Zhao L.C. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016;117:226–234. - PubMed
1. EAU. EAU guidelines on trauma. 2019. https://uroweb.org/guideline/urological-trauma/.

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[1] Santucci R.A., Wessells H., Bartsch G., et al. Evaluation and management of renal injuries: consensus statement of the Renal Trauma Subcommittee: Renal Trauma Consensus statement. BJU Int. 2004;93:937–954. - PubMed

[2] Santucci R.A., Wessells H., Bartsch G., et al. Evaluation and management of renal injuries: consensus statement of the Renal Trauma Subcommittee: Renal Trauma Consensus statement. BJU Int. 2004;93:937–954. - PubMed

[3] Sujenthiran A., Elshout P.J., Veskimae E., et al. Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review. Eur Urol Focus. 2019;5:290–300. - PubMed

[4] Sujenthiran A., Elshout P.J., Veskimae E., et al. Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review. Eur Urol Focus. 2019;5:290–300. - PubMed

[5] Peyronnet B., Mathieu R., Couapel J.-P., Verhoest G., Bensalah K. Traumatismes fermés du rein et de l’uretère. EMC Urol. 2012;5:1–10.

[6] Peyronnet B., Mathieu R., Couapel J.-P., Verhoest G., Bensalah K. Traumatismes fermés du rein et de l’uretère. EMC Urol. 2012;5:1–10.

[7] Bryk D.J., Zhao L.C. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016;117:226–234. - PubMed

[8] Bryk D.J., Zhao L.C. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016;117:226–234. - PubMed

[9] EAU. EAU guidelines on trauma. 2019. https://uroweb.org/guideline/urological-trauma/.

[10] EAU. EAU guidelines on trauma. 2019. https://uroweb.org/guideline/urological-trauma/.

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Impact of Hospital Volume on the Outcomes of Renal Trauma Management

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Impact of Hospital Volume on the Outcomes of Renal Trauma Management

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