Contemporary management of penetrating renal trauma - A national analysis

•Nationwide, 18% of patients with a penetrating injury to the kidney are offered nonoperative management.•With a success rate of 92%, patients are being appropriately selected for nonoperative management.•Concomitant abdominal injuries & higher grade kidney injuries predict failure of nonoperative management. Indications for nonoperative management (NOM) after penetrating renal injury remain ill-defined. Using a national database, we sought to describe the experience of operative and nonoperative management in the United States and retrospectively examine risk factors for failure of NOM. The TQIP database 2010–2016 was used to identify patients with penetrating renal trauma. Outcomes of patients treated with an immediate operation (IO) and NOM are described. Failure of NOM was defined as the need for a renal operation after 4 h from arrival. Univariate then multivariable regression analyses were performed to identify predictors of NOM failure. Out of 8139 patients with kidney trauma, 1,842 had a penetrating mechanism of injury and were included. Of those, 89% were male, median age was 28 years, and 330 (18%) were offered NOM. Compared to IO, NOM patients were less likely to have gunshot wound (59% vs 89% p