PD29-03: Impact of hospital volume on the outcomes of renal trauma management

Paul BALOCHE, Nicolas SZABLA, Caen, France, Lucas FRETON, Rennes, France, Marine HUTIN, Montpellier, France, Marina RUGGIERO, Paris, France, Inès DOMINIQUE, Lyon, France, Clémentine MILLET, Clermont Ferrand, France, Sébastien BERGERAT, Strasbourg, France, Paul PANAYOTOPOULOS, Angers, France, Reem BETARI, Amiens, France, Xavier MATILLON, Lyon, France, Ala CHEBBI, Rouen, France, Thomas CAES, Lille, France, Pierre-Marie PATARD, Toulouse, France, Nicolas BRICHART, Orléans, France, Laura SABOURIN, Clermont Ferrand, France, Charles DARIANE, Paris, France, Michael BABOUDJIAN, Bastien GONDRAN-TELLIER, Nantes, France, Cédric LEBACLE, Paris, France, François-Xavier MADEC, Nantes, France, François-Xavier NOUHAUD, Rouen, France, Xavier ROD, Nantes, France, Gaelle FIARD, Grenoble, France, Benjamin PRADERE, Tours, France, Benoit PEYRONNET*, Rennes, France

Introduction: Some healthcare systems have set up referral trauma center 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. The aim of our study was to evaluate the impact of hospital volume on the outcomes of renal trauma management in a European healthcare system.

Methods: A retrospective multicenter study was conducted, including all patients admitted for renal trauma in 17 hospitals between 2005 and 2015. To evaluate the impact of HV we divided patients into four quartiles according to the caseload per year: low volume (=8/year), moderate volume (9-13/year), high volume (14-25/year), and very high volume (=26/year). The primary endpoint was failure of non-operative management defined as any interventional radiology (IR) or surgical procedure needed within the first 30 days after admission.

Results: Of 1771 patients with renal trauma, 1704 were included. There were significantly more non-operative managements in the very high and low volume centers (84.6% vs. 76.9% vs. 78.5% vs. 81.6%; p=0.02). Early follow-up imaging was used more commonly in lower volume centers (86.1% vs. 83.9% vs. 73.8% vs. 81%; p=0.0007). In univariate logistic regression analysis, very high hospital volume was significantly associated with a lower risk of non-operative management failure when compared to low (OR=0.54; p=0.05) and moderate hospital volume (OR=0.48; p=0.02). There were significantly less nephrectomies in the high and very high volume groups (0.9% and 0.5% vs. 1.9% and 3.5%; p=0.003). In multivariate analysis very high volume remained significantly associated with a lower risk of non-operative management failure compared to low (OR=0.48; p=0.04) and moderate volume (OR=0.42; p=0.01).

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

Source of Funding: none