Evaluación del rol del equipo de coordinación de nefrología en la consulta externa específica de acceso vascular. ¿Qué podemos aportar de nuevo?

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia Pub Date : 2025-02-01 DOI:10.1016/j.nefro.2024.08.002

Néstor Fontseré , Gaspar Mestres , Xavi Yugueros , Daniel Gil , Carla Blanco , Valentín Lozano , Lidia María Rodas , Arantxa Gelabert , Paula Escarcena , Rosa Ramos , Francisco Maduell

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引用次数: 0

Abstract

Background and objectives

The key points of a monographic vascular access (VA) consultation are an adequate preoperative assessment, as well as a correct management and optimization of waiting lists. Our main objective of present study was to evaluate the degree of exploratory-dependent concordance in outpatient clinics regarding implanted VA, between nephrology and vascular surgery.

Materials and methods

We analyzed VA created or surgically repaired between 2021 and 2022. We compared the differences in the preoperative variables between the groups in which the assessments between the two teams were coincident and non-coincident, and the primary (PP) and secondary (PS) patencies during the follow-up period (Kapplan-Meier curves and Log-rank test, and Cox regression analysis). Significant P≤.05.

Results

A total of 605 VA creations or repairs were analyzed: 74 ligations (12.2%), 207 distal arterio-venous fistulaes (AVF) (34.3%), 237 proximal AVF (39.2%), 35 repairs (5.7%), 41 grafts (6.7%) and 11 others (1.9%). After an average waiting list time of 16.5 ± 11.6 days, excluding ligations, adequate 1-month maturation was observed in 87.6% of cases. A total of 158 endovascular procedures and 17 surgical repairs were performed during postoperative follow-up. Primary (PP) and secondary (PS) patencies at 6, 12 and 24 months were PP: 76.2%, 64.9%, 57.5% and PS: 86.4%, 81.2%, 74.7%, respectively. Of the total number of procedures, nephrology obtained an adequate degree of agreement in 93.6% of the cases (kappa index: 0.886). The preoperative factors associated with greater discrepancies in assessments were age (P=.022) and arterial diameter (P =.032). The subgroup of non-matched assessments between nephrology and vascular surgery (39 cases) presented a similar PP (at 2 years: 59.2% vs 41.3%, P =.099) but worse PS (at 2 years: 76.6% vs 55.4%, P =.005).

Conclusions

No significant observer-dependent differences (nephrologist vs. vascular surgeon) were observed in decision-making regarding the surgical procedure to be performed (93.6% agreement), and discordant cases presented worse secondary patency. After specific training, the nephrology coordination team can make a proper optimisation of social and health resources by reserving referrals to vascular surgery for those cases of greater complexity.

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评价肾病协调小组在血管通路特异性门诊中的作用。我们还能带来什么？

背景与目的血管单通会诊的关键是充分的术前评估，以及正确的管理和优化候诊名单。我们本研究的主要目的是评估门诊关于植入式静脉曲张的探索依赖的一致性程度，肾内科和血管外科之间的一致性。材料和方法我们分析了2021年至2022年期间产生或手术修复的VA。我们比较两组评估一致组和非一致组术前变量的差异，以及随访期间主要（PP）和次要（PS）的差异（Kapplan-Meier曲线、Log-rank检验和Cox回归分析）。显著P≤0。。结果共分析605例VA的创建或修复：结扎74例（12.2%），远端动静脉瘘207例（34.3%），近端动静脉瘘237例（39.2%），修复35例（5.7%），移植物41例（6.7%），其他11例（1.9%）。在平均等待时间为16.5±11.6天（不包括结扎）后，87.6%的病例观察到足够的1个月成熟。术后随访期间共行158例血管内手术和17例手术修复。6、12、24个月原发性（PP）和继发性（PS）分别为PP: 76.2%、64.9%、57.5%和PS: 86.4%、81.2%、74.7%。在所有手术中，93.6%的病例（kappa指数：0.886）获得了足够程度的一致性。术前评估差异较大的相关因素是年龄（P= 0.022）和动脉直径（P= 0.032）。肾内科和血管外科之间的非匹配评估亚组（39例）显示相似的PP(2年：59.2%对41.3%,P = 0.099)，但更差的PS（2年：76.6%对55.4%,P = 0.005）。结论肾内科医生与血管外科医生在决定手术方式方面无明显的观察者依赖差异（93.6%一致），不一致的病例继发通畅程度较差。经过专门的培训，肾病协调小组可以通过为那些更复杂的病例保留转血管手术来适当优化社会和卫生资源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nefrologia 医学-泌尿学与肾脏学

CiteScore

3.40

自引率

7.70%

发文量

148

审稿时长

47 days

期刊介绍： Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.