Care pathway reduces hospitalizations and cost for hemodialysis vascular access surgery

Becker, Bryan N.; Breiterman-White, Randee; Nylander, William; Fotiadis, Chris; Richie, Robert E.; Schulman, Gerald

doi:10.1016/s0272-6386(97)90312-7

Cited by 22 publications

(9 citation statements)

References 17 publications

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“…The type of VA is associated with patient outcome. Tunneled catheters, for example, have been associated with increased risk of luminal thrombosis, central venous stenosis, inadequate blood flow rate, inadequate dialysis, increased risk of infection, increased risk of hospitalization, increased risk of death, and high cost . AVG has also been associated with graft stenosis, fivefold increase in infection risk, poorer long‐term patency, and higher levels of complications and interventions .…”

Section: Introductionmentioning

confidence: 99%

“…Tunneled catheters, for example, have been associated with increased risk of luminal thrombosis, central venous stenosis, inadequate blood flow rate, inadequate dialysis, increased risk of infection, increased risk of hospitalization, increased risk of death, and high cost. [2][3][4][5] AVG has also been associated with graft stenosis, fivefold increase in infection risk, poorer long-term patency, and higher levels of complications and interventions. 6 The Kidney Disease: Improving Global Outcomes guidelines published in 2001 7 defined the ideal VA as that which (1) delivers adequate flow rate for the dialysis prescription, (2) has a long use-life, and (3) has a low rate of complications (infection, stenosis, thrombosis, aneurysm, and limb ischemia).…”

Section: Introductionmentioning

confidence: 99%

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Improving arteriovenous fistula rate: Effect on hemodialysis quality

Karkar

Chaballout

Ibrahim

et al. 2013

Hemodialysis International

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Vascular access (VA) is the lifeline for patients with end-stage renal disease on regular hemodialysis (HD). Tunneled catheters have been associated with increased risk of luminal thrombosis, infection, hospitalization, and high cost. Our aims were to follow the "Fistula First Initiative," avoid or reduce the rate of catheter insertion, improve the rate of arteriovenous fistula (AVF) use, and study the effect of increased AVF use on quality of dialysis and patient's outcome. A VA program has been established in collaboration with an enthusiastic and professional vascular surgery team to manage 358 patients who have been on regular HD treatment for a period ranging from 1 to 252 months. The mean ± standard deviation age of patients was 52 ± 15 years with 62% male patients. Over a period of 2 years, 408 procedures were performed. These include 293 AVFs and 56 arteriovenous grafts (AVGs). Other procedures include 39 permanent catheter insertions, 8 AVF aneurysmectomy, removal of 6 AVGs, embolectomy of 4 AVGs, excision of 1 AVG lymphocele, and ligation of 1 AVF. This program resulted in significant increase in AVF rate from 35% to 82%; reduction in catheter rate from 62% to 10.9%; infection rate down from 6.6% to 0.6%; VA clotting down from 5.1% to 1.0%; and increase in average blood flow rate from 214 ± 32 to 298 ± 37 mL/min (P < 0.01). These results have been associated with improved average single pool Kt/V from 0.88 ± 0.19 to 1.28 ± 0.2 (P < 0.01); increased hemoglobin from 9.2 ± 1.2 to 10.9 ± 0.9 g/dL (P < 0.01); improved serum albumin from 3.2 ± 0.5 to 3.7 ± 0.4 g/dL (P < 0.05); reduction in administered erythropoietin dose by 19%; and significant drop in hospitalization rate from 6.1% to 3.8%. These results confirm the great benefits of AVF on quality of HD and patient outcome, and clearly affirm that AVF should always be considered first.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving arteriovenous fistula rate: Effect on hemodialysis quality

Karkar

Chaballout

Ibrahim

et al. 2013

Hemodialysis International

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“…Nicht zuletzt sind ältere Literaturstellen aufgrund der zeitraumbedingten Kostenän-derungen kaum noch vergleichbar [2,12].…”

Section: Introductionunclassified

Erfahrungen mit der ambulanten arteriovenösen Shuntchirurgie Eine Kosten-Nutzen-Analyse

Meyer

Müller

Bürger

et al. 2002

Chirurg

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Placement of arteriovenous (av) fistulas has been executed at the reporting surgical department for 3 years. Calculation of the reimbursement by the insurance companies is based on the so-called "Unique Evaluation Table" (Einheitlicher Bewertungsmassstab). The aim of the study was to evaluate the efficiency of the placement of av fistulas in an out-patient setting and the acceptance of this approach in the patients. The costs based on an average of the duration of the intervention and treatment at the out-patient clinic per time unit for surgeon, nurse and operating room, as well as costs for use of specific materials were listed, summarized, and compared with the amount of money which was reimbursed by the insurance companies according to the "Unique Evaluation Table". During the 3-year time period, 67 patients underwent 70 placements of av fistulas in an out-patient setting (in total, 532 interventions). Patients answered a questionnaire, and procedures were evaluated for average costs. Based on the table-dependent reimbursement of DM 274.00 (according to the "Unique Evaluation Table"), costs of DM 497.94 (DM 445.50 for 54 min of mean duration of surgical procedure plus DM 52.44 for materials) were determined, indicating that no full reimbursement was found despite the fact that there was only a minimal rate of early complications (thrombosis, n = 2 [3%]) (infection, n = 1 [1.5%]). The expenses were 81.7% on average above the level of the reimbursement. In conclusion, despite high acceptance of an out-patient setting for placement of av fistulas in patients (82%), it is not efficient from an economic point of view and can be only provided for specifically selected cases. Therefore, it is not advisable at present to place av fistulas at German out-patient clinics with no following admission of the patients, to avoid financial disadvantages for the surgical department. New negotiations between the medical profession and the insurance companies are urgently needed to ensure an improved financial outcome for the clinics.

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“…The type of vascular access is associated with patient outcome. Despite the recent improvement and advanced technology of catheters, temporary and permanent catheters have been associated with increased incidence of luminal thrombosis, central venous stenosis, inadequate blood flow rate, inadequate dialysis, increased risk of infection, increased risk of hospitalization, increased risk of death and high cost [54][55][56][57][58][59][60][61]. AVG has also been associated with bleeding, infection and graft failure.…”

Section: Efficient Hemodialysismentioning

confidence: 99%

Advances in Hemodialysis Techniques

Karkar¹

2013

Hemodialysis

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Care pathway reduces hospitalizations and cost for hemodialysis vascular access surgery

Cited by 22 publications

References 17 publications

Improving arteriovenous fistula rate: Effect on hemodialysis quality

Improving arteriovenous fistula rate: Effect on hemodialysis quality

Erfahrungen mit der ambulanten arteriovenösen Shuntchirurgie Eine Kosten-Nutzen-Analyse

Advances in Hemodialysis Techniques

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