Factors Associated with Cancellation of Arteriovenous Access Creations.

Abstract

Background: Cancellation of arteriovenous (AV) access creation delays establishing permanent hemodialysis (HD) access, potentially affecting patient outcomes and healthcare efficiency. Our goal was to assess the rate of AV access cancellations and identify contributing factors in a safety net hospital.

Methods: All AV access creations at a single academic medical center (2018- 2024) were retrospectively reviewed. Reasons for outpatient and inpatient AV access creation cancellations on the planned day and week scheduled were analyzed using chart review. A multivariable analysis was performed to assess for predictors of same-day outpatient cancellations.

Results: There were 584 patients who were scheduled for an AV access creation during the study period. 17.7% had same-day cancellations and 7.7% had week-before cancellations. The most common reasons for same-day cancellation were acute illness (21.4%), CKD-related complications (21.4%), logistical issues (11.7%), and inadequate pre-operative preparation (13.6%). The most common reasons for cancellations one week-before scheduled operation were patient choice (22.7%) acute illness (20.5%), inadequate pre-operative preparation (20.5), and logistical issues (11.4%). On multivariable analysis, same-day outpatient cancellations were significantly associated with an afternoon case start time (OR 3.09, 95% CI 0.75-2.37, P<.001). The median time to AV access creation following a cancellation was 32 days. However, among same-day cancellations, 14.3% of patients did not proceed with permanent HD access within 6 months, and 7% required an interval tunneled dialysis catheter (TDC). Among week-before cancellations, 16.7% did not proceed with permanent HD access within 6 months, and 4.7% required an interval TDC.

Conclusion: Cancellations of AV access creations affected a quarter of scheduled cases with several patients not proceeding with permanent HD access by 6 months. Acute illness, poor control of CKD-related complications, and logistical factors were among the most common reasons for cancellations, highlighting potential areas for targeted improvement. Targeted efforts such as scheduling optimization and improved pre-operative preparation may help reduce surgical cancellations and prevent unnecessary catheter placements. These interventions are also likely to enhance the overall quality of hemodialysis care for patients.