Hemodialysis vascular access and surgical training.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:158A 1997
In a multicenter study involving 5 hospitals and which included 85% of all vascular access graft procedures done over a 4.5 year period, the incidence of vascular access failure, defined as need for intervention, was evaluated as a function of level of surgical supervision present at time of graft insertion; e.g., whether the graft had been placed in the presence of an attending surgeon or not. 87% of the grafts were placed with an attending present. In 3.4% a surgical fellow was present, whereas in 9.7% the surgical resident was the highest level of training represented.
The relative risk for access failure (length of follow-up unspecified) was 2.2 for non-infectious causes when the placement had not been supervised by attending. The relative risk for infectious failure (used perhaps as a control) was 1.6 (p NS) when an attending had not been present at time of insertion.
Comment: This study purports to demonstrate that the level of surgical expertise present at graft insertion may improve graft patency rates. However, the factors associated with presence or absence of an attending surgeon at time of graft placement (insurance, Medicaid patient vs. privately insured) need to be explored, as these may affect graft patency rates independent of surgery-related factors. (John Ball, M.D., Illinois Masonic Hospital, Chicago, IL)
To go back use the BACK button on your browser. Otherwise click on the desired link to this article below:
ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : Vascular Access: graft/fistula