Streamlining Preoperative Evaluation for Dialysis Access: A Pilot Study

Abstract

Background: Outpatient in-person clinic evaluation is the standard consultation practice for an initial referral for hemodialysis (HD) access. However, most factors predicting the complexity of first-time access surgery can be determined from history rather than physical exam. This study compares the outcomes of patients undergoing first-time arteriovenous fistula creation screened with a standardized preoperative phone interview and no preoperative clinic visit (SPEEDY group) to those opting for a standard in-person clinic visit.

Methods: From September 2021 to August 2022, all patients scheduled in our vascular surgery clinic for first-time dialysis access were interviewed via telephone using a standardized history questionnaire. Those meeting criteria and expressing desire to bypass the initial clinic visit were scheduled for surgery without an in-person preoperative evaluation (SPEEDY group). The comparison group included patients who were study-eligible but desired to meet with the surgeon preoperatively. Time from referral to fistula creation, overall fistula patency rates, and the incidence of access-specific complications were compared between the 2 groups.

Results: Of the 107 patients contacted, 43 (40%) were study eligible. Of these eligible patients, 21 (49%) were scheduled for surgery without a preoperative visit, of whom 19 (90%) underwent surgery. Compared to eligible controls, SPEEDY patients had a younger median age (49.3 years vs. 58.9, P = 0.056) but similar median duration of HD prior to fistula creation. SPEEDY patients had a significantly shorter median time from initial referral to surgery than eligible controls (48 days vs. 82, P = 0.01). Incidence of complications did not differ between the groups. At a median follow up time of 18.3 months (IQR 11.4-20.9) there was no difference in overall access patency between SPEEDY participants and eligible controls (P = 0.83).

Conclusions: A standardized telephone questionnaire can effectively be used to identify patients who can safely undergo first time dialysis access surgery without an in-person clinic evaluation, significantly reducing time from initial referral to surgery without increasing complications or compromising patency rates.