Hemodialysis Vascular Access: Rising Costs as a Surrogate Marker for Patency and Function of Arteriovenous Fistulas.
Hemodialysis Vascular Access: Rising Costs as a Surrogate Marker for Patency and Function of Arteriovenous Fistulas.
- 2017
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Establishment and maintenance of vascular access for hemodialysis is life-sustaining for patients needing renal-replacement therapy. Arteriovenous fistulas (AVFs) are the preferred type of access, but the costs associated with creation and maintenance are poorly characterized, especially with respect to patient characteristics. CONCLUSIONS: Hemodialysis access maintenance contributes significantly to the healthcare burden of renal disease. Our data suggest that particular patient characteristics factor into patency and costs. Short-term mounting costs associated with AVF maintenance may portend poor long-term patency. Rising healthcare costs cannot be easily controlled without understanding the clinical factors driving them. Copyright © 2016 Elsevier Inc. All rights reserved. METHODS: A prospectively maintained registry has been established at The Mount Sinai Hospital for patients undergoing access procedures since 2007. We studied 163 patients undergoing successfully placed and cannulated AVFs as their first permanent ipsilateral access and for whom 3-year follow-up was available, including 18 patients with failed contralateral AVFs. Records were analyzed for institutional inpatient and outpatient procedures related to access maturation, imaging, catheter-related procedures, and revisions. We determined hospital costs for 3 AVF locations, assessing the contribution of various factors to variation in costs and patency. RESULTS: The median first-year cost of patent AVFs was
English
0890-5096
*Arteriovenous Shunt, Surgical/ec [Economics]
*Hospital Costs
*Kidney Failure, Chronic/ec [Economics]
*Kidney Failure, Chronic/th [Therapy]
*Renal Dialysis/ec [Economics]
*Vascular Patency
Aged
Arteriovenous Shunt, Surgical/ae [Adverse Effects]
Cost Control
Cost-Benefit Analysis
Female
Graft Occlusion, Vascular/ec [Economics]
Graft Occlusion, Vascular/et [Etiology]
Graft Occlusion, Vascular/th [Therapy]
Humans
Kidney Failure, Chronic/di [Diagnosis]
Male
Middle Aged
New York City
Registries
Retreatment/ec [Economics]
Retrospective Studies
Time Factors
Treatment Outcome
MedStar Washington Hospital Center
Surgery/Vascular Surgery
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Establishment and maintenance of vascular access for hemodialysis is life-sustaining for patients needing renal-replacement therapy. Arteriovenous fistulas (AVFs) are the preferred type of access, but the costs associated with creation and maintenance are poorly characterized, especially with respect to patient characteristics. CONCLUSIONS: Hemodialysis access maintenance contributes significantly to the healthcare burden of renal disease. Our data suggest that particular patient characteristics factor into patency and costs. Short-term mounting costs associated with AVF maintenance may portend poor long-term patency. Rising healthcare costs cannot be easily controlled without understanding the clinical factors driving them. Copyright © 2016 Elsevier Inc. All rights reserved. METHODS: A prospectively maintained registry has been established at The Mount Sinai Hospital for patients undergoing access procedures since 2007. We studied 163 patients undergoing successfully placed and cannulated AVFs as their first permanent ipsilateral access and for whom 3-year follow-up was available, including 18 patients with failed contralateral AVFs. Records were analyzed for institutional inpatient and outpatient procedures related to access maturation, imaging, catheter-related procedures, and revisions. We determined hospital costs for 3 AVF locations, assessing the contribution of various factors to variation in costs and patency. RESULTS: The median first-year cost of patent AVFs was
English
0890-5096
*Arteriovenous Shunt, Surgical/ec [Economics]
*Hospital Costs
*Kidney Failure, Chronic/ec [Economics]
*Kidney Failure, Chronic/th [Therapy]
*Renal Dialysis/ec [Economics]
*Vascular Patency
Aged
Arteriovenous Shunt, Surgical/ae [Adverse Effects]
Cost Control
Cost-Benefit Analysis
Female
Graft Occlusion, Vascular/ec [Economics]
Graft Occlusion, Vascular/et [Etiology]
Graft Occlusion, Vascular/th [Therapy]
Humans
Kidney Failure, Chronic/di [Diagnosis]
Male
Middle Aged
New York City
Registries
Retreatment/ec [Economics]
Retrospective Studies
Time Factors
Treatment Outcome
MedStar Washington Hospital Center
Surgery/Vascular Surgery
Journal Article