Readmissions Following Arteriovenous Access Creation for Haemodialysis in a French National Database

Raphael Coscas; Nicoleta Petrica; Ziad Massy; Jérémie Jayet; Jérôme De Launay

doi:10.1016/j.ejvs.2022.08.013

Readmissions Following Arteriovenous Access Creation for Haemodialysis in a French National Database

Eur J Vasc Endovasc Surg. 2022 Dec;64(6):703-710. doi: 10.1016/j.ejvs.2022.08.013. Epub 2022 Aug 19.

Authors

Raphael Coscas¹, Nicoleta Petrica², Ziad Massy³, Jérémie Jayet⁴, Jérôme De Launay⁵

Affiliations

¹ Department of Vascular Surgery, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France. Electronic address: rcoscas@gmail.com.
² IQVIA, Courbevoie, France.
³ Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France; Department of Nephrology, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
⁴ Department of Vascular Surgery, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France.
⁵ Becton, Dickinson and Company - BD Interventional, Health Economics Department, Voisins-le-Bretonneux, France.

PMID: 35988860
DOI: 10.1016/j.ejvs.2022.08.013

Abstract

Objective: There is a lack of large real world data on arteriovenous (AV) access results. This study aimed to describe the required hospital care during the first year following creation of AV access.

Methods: Data from all adult patients who underwent creation of AV access performed in 2017 in a public or private facility were collected through the French national hospitalisation database. Patients were classified into two groups ("de novo" and "secondary") according to their history of prior AV access creation. The primary outcome was the proportion of patients with at least one hospital readmission related to the AV access recorded during the first 12 post-operative months.

Results: In 2017, 10 476 adult patients underwent AV access creation in France, including 8 690 (83%) de novo creations. An AV fistula was created for 92% of the patients (95% de novo vs. 78% secondary; p < .001). During the first 12 post-operative months, 6 591 (63%) patients recorded at least one related readmission (68% secondary vs. 62% de novo; p < .001). A total of 5 557 (53%) recorded a readmission for surgical/interventional procedure and 2 852 (27%) were observed with a readmission for medical complications. The mean (± standard deviation) number of related readmissions at 12 months was 1.4 ± 1.6 per patient (1.7 ± 1.9 secondary vs. 1.3 ± 1.5 de novo; p < .001). Patients with an AV graft were more frequently readmitted than those with an AV fistula (1.8 ± 2 vs. 1.3 ± 1.5 readmission; p < .001).

Conclusion: This study highlights the high frequency of readmissions during the first 12 months following creation of AV access, particularly in patients who had already undergone creation of a previous AV access or had an AV graft implanted. Further research should focus on tailoring AV access strategies to improve patient quality of life and decrease the healthcare cost burden.

Keywords: Arteriovenous shunt; Epidemiology; Public health practice France; Renal dialysis; Vascular surgical procedures.

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MeSH terms

Adult
Arteriovenous Shunt, Surgical* / adverse effects
Arteriovenous Shunt, Surgical* / methods
Fistula* / etiology
Humans
Kidney Failure, Chronic*
Patient Readmission
Quality of Life
Renal Dialysis / methods
Retrospective Studies
Time Factors
Treatment Outcome