Arteriovenous Fistula Creation and Care in an Office-Based Practice Compared to Hospital Based Care.

Abstract

Objectives: This study evaluates and compares outcomes of arteriovenous fistulas (AVFs) created in a dialysis access dedicated office-based laboratory (OBL) and outpatient hospital setting.

Methods: All consecutive outpatient surgical autologous AVFs created at an academic hospital, community hospital, and an OBL from 2016-2020 were reviewed. Demographics, comorbidities, surgical procedure, complications, maturation, patency, and procedures for maintenance were assessed from time of surgical evaluation to latest available documentation. Complications, maturation, and patency were compared by location of surgery and post-operative access-related care, creating three groups: surgery and follow-up in hospital (Hospital), surgery in hospital and follow-up in OBL (Hybrid), or surgery and follow-up in OBL (OBL).

Results: 389 AVFs were included. 138 were in the Hospital group, 125 in the Hybrid group, and 126 in the OBL group. Median follow-up time was 34.7 months. Mean age was 59 years. Percentage of male patients was 58%. The three groups did not differ with respect to demographics and comorbidities. Peri-operative complication rate was 6.4% among 263 hospital outpatient procedures and 1.6% among 126 OBL procedures (p=0.043). Maturation rate was lower in the Hospital group (54%) than the Hybrid (86%) and OBL (93%) groups irrespective of AVF type (p<0.001) (Figure 1). Mean time to approval for use was 52 days in the OBL group, 66 days in the Hybrid group, and 98 days in the Hospital group (p<0.001). The OH group had the highest primary patency, but the lowest functional patency (Figure II). During the follow-up period, there was a significant difference in number of procedures per year of functional patency, with 0.7 in the Hospital group, 2.1 in the Hybrid group, and 2.1 in the OBL group (p<0.001).

Conclusions: Surgical AVF creation in a dialysis access dedicated OBL is safe and associated with lower perioperative complications, higher maturation rate, better functional patency, and decreased time to approval for use as compared to patients receiving hospital-based care only. Similar results were seen among hospital created fistula patients who received subsequent care at an OBL. Dialysis access creation and care in AV Access dedicated OBLs is associated with improved outcomes as compared to hospital-based care.