Kidney Week

Abstract: SA-PO951

Surgeon Variation in Dialysis Vascular Access Outcomes in the United States

Session Information

• Dialysis: Vascular Access - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 704 Dialysis: Vascular Access

Authors

• Shahinian, Vahakn, University of Michigan, Ann Arbor, Michigan, United States

Vahakn Shahinian,

• Zhang, Xiaosong, University of Michigan, Ann Arbor, Michigan, United States

Xiaosong Zhang,

• Tilea, Anca, University of Michigan, Ann Arbor, Michigan, United States

Anca Tilea,

• He, Kevin, University of Michigan, Ann Arbor, Michigan, United States

Kevin He,

• Schaubel, Douglas E., University of Michigan, Ann Arbor, Michigan, United States

Douglas E. Schaubel,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

• Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States

Rajiv Saran,

• Woodside, Kenneth J., University of Michigan, Ann Arbor, Michigan, United States

Kenneth J. Woodside,

Background

An arteriovenous fistula (AVF) is the access of choice for most patients on chronic hemodialysis. Operating surgeon characteristics have been proposed as contributors to successful AVF creation and AVF survival, but previous studies have been limited by small sample size. We examined surgeon-related vascular access outcomes at the national level.

Methods

From the United States Renal Data System, we used Medicare claims and web-based data submitted by dialysis facilities to examine the primary outcome: % of AVFs with successful use within 6 months of placement, i.e. ‘maturation’, over the period 2013-2014. A multilevel logistic regression model was used to examine the association of surgeon characteristics (year of graduation, type of surgical specialty, volume, ie number of AVF placements per year) with the outcome, adjusted for patient characteristics (age, sex, race, comorbidities, dialysis vintage, prior access placement) and dialysis facility effects.

Results

Over the study period, 2,770 surgeons were identified as placing at least 5 AVFs, with a total of 49,826 AVF placements. The median AVF maturation rate was 59% (interquartile range 44% to 71%). In the model, more recent year of medical school graduation, but not surgical specialty (general surgery, transplant surgery, vascular surgery) was associated with higher odds of AVF maturation. In addition, increasing historical volume of AVF placement was associated with higher odds of successful AVF maturation: odds ratio 1.46 (95%CI 1.37-1.57) for highest (>84 AVF placements in 2 years) vs lowest (<14) volume quintile. Expressed as AVF maturation probability, outcomes varied from 56.8% to 66.6% from lowest to highest volume decile (Figure).

Conclusion

We observed wide surgeon level variation and a strong surgeon volume-outcome relationship for the outcome of AVF maturation.

Funding

• NIDDK Support