ArticleAnnals of vascular surgery2025
Streamlining Preoperative Evaluation for Dialysis Access: A Pilot Study.
Article in Annals of vascular surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
backgroundOutpatient in-person clinic evaluation is the standard consultation practice for an initial referral for hemodialysis (HD) access. However, most factors predicting the complexity of first-time access surgery can be determined from history rather than physical exam. This study compares the outcomes of patients undergoing first-time arteriovenous fistula creation screened with a standardized preoperative phone interview and no preoperative clinic visit (SPEEDY group) to those opting for a standard in-person clinic visit.
methodsFrom September 2021 to August 2022, all patients scheduled in our vascular surgery clinic for first-time dialysis access were interviewed via telephone using a standardized history questionnaire. Those meeting criteria and expressing desire to bypass the initial clinic visit were scheduled for surgery without an in-person preoperative evaluation (SPEEDY group). The comparison group included patients who were study-eligible but desired to meet with the surgeon preoperatively. Time from referral to fistula creation, overall fistula patency rates, and the incidence of access-specific complications were compared between the 2 groups.
resultsOf the 107 patients contacted, 43 (40%) were study eligible. Of these eligible patients, 21 (49%) were scheduled for surgery without a preoperative visit, of whom 19 (90%) underwent surgery. Compared to eligible controls, SPEEDY patients had a younger median age (49.3 years vs. 58.9, P = 0.056) but similar median duration of HD prior to fistula creation. SPEEDY patients had a significantly shorter median time from initial referral to surgery than eligible controls (48 days vs. 82, P = 0.01). Incidence of complications did not differ between the groups. At a median follow up time of 18.3 months (IQR 11.4-20.9) there was no difference in overall access patency between SPEEDY participants and eligible controls (P = 0.83).
conclusionsA standardized telephone questionnaire can effectively be used to identify patients who can safely undergo first time dialysis access surgery without an in-person clinic evaluation, significantly reducing time from initial referral to surgery without increasing complications or compromising patency rates.
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