Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California.
Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, California.
J Am Soc Nephrol. 2024 Jan 1;35(1):85-93. doi: 10.1681/ASN.0000000000000250. Epub 2023 Oct 17.
The Advancing American Kidney Health Initiative aims to increase rates of utilization of peritoneal dialysis (PD) in the United States. One of the first steps to PD is successful catheter placement, which can be performed by surgeons, interventional radiologists, or nephrologists. We examined the association between operator subspecialty and risk of needing a follow-up procedure in the first 90 days after initial PD catheter implantation. Overall, we found that 15.5% of catheters required revision, removal, or a second catheter placement within 90 days. The odds of requiring a follow-up procedure was 36% higher for interventional radiologists and 86% higher for interventional nephrologists compared with general surgeons. Further research is needed to understand how to optimize the function of catheters across different operator types.
The US government has implemented incentives to increase the use of PD. Successful placement of PD catheters is an important step to increasing PD utilization rates. Our objective was to compare initial outcomes after PD catheter placement by different types of operators.
We included PD-naïve patients insured by Medicare who had a PD catheter inserted between 2010 and 2019. We examined the association between specialty of the operator (general surgeon, vascular surgeon, interventional radiologist, or interventional nephrologist) and odds of needing a follow-up procedure, which we defined as catheter removal, replacement, or revision within 90 days of the initial procedure. Mixed logistic regression models clustered by operator were used to examine the association between operator type and outcomes.
We included 46,973 patients treated by 5205 operators (71.1% general surgeons, 17.2% vascular surgeons, 9.7% interventional radiologists, 2.0% interventional nephrologists). 15.5% of patients required a follow-up procedure within 90 days of the initial insertion, of whom 2.9% had a second PD catheter implanted, 6.6% underwent PD catheter removal, and 5.9% had a PD catheter revision within 90 days of the initial insertion. In models adjusted for patient and operator characteristics, the odds of requiring a follow-up procedure within 90 days were highest for interventional nephrologists (HR, 1.86; 95% confidence interval [CI], 1.56 to 2.22) and interventional radiologists (odds ratio, 1.36; 95% CI, 1.17 to 1.58) followed by vascular surgeons (odds ratio, 1.06; 95% CI, 0.97 to 1.14) compared with general surgeons.
The probability of needing a follow-up procedure after initial PD catheter placement varied by operator specialty and was higher for interventionalists and lowest for general surgeons.
声明：美国肾脏病提升计划旨在提高美国腹膜透析（PD）的使用率。进行 PD 的第一步是成功置管，这可以由外科医生、介入放射科医生或肾病医生来完成。我们研究了操作人员专业领域与初始 PD 导管植入后 90 天内需要后续治疗的风险之间的关系。总的来说，我们发现 15.5%的导管在 90 天内需要重新置管、移除或第二次置管。与普通外科医生相比，介入放射科医生需要后续治疗的可能性高 36%，介入肾病医生高 86%。需要进一步研究以了解如何优化不同操作人员类型的导管功能。
背景：美国政府已经实施了激励措施来提高 PD 的使用。成功放置 PD 导管是提高 PD 使用率的重要步骤。我们的目标是比较不同操作人员类型初始 PD 导管放置后的结果。
方法：我们纳入了 Medicare 保险的 PD 初治患者，这些患者在 2010 年至 2019 年间进行了 PD 导管插入。我们研究了操作人员的专业领域（普通外科医生、血管外科医生、介入放射科医生或介入肾病医生）与需要后续治疗的可能性（定义为初始手术后 90 天内导管移除、更换或修正）之间的关联。使用按操作人员聚类的混合逻辑回归模型来检查操作人员类型与结果之间的关联。
结果：我们纳入了 46973 名患者，由 5205 名操作人员治疗（71.1%为普通外科医生，17.2%为血管外科医生，9.7%为介入放射科医生，2.0%为介入肾病医生）。15.5%的患者在初始插入后 90 天内需要进行后续治疗，其中 2.9%的患者需要再次植入 PD 导管，6.6%的患者进行了 PD 导管移除，5.9%的患者在初始插入后 90 天内进行了 PD 导管修正。在调整了患者和操作人员特征后，介入肾病医生（HR，1.86；95%置信区间[CI]，1.56 至 2.22）和介入放射科医生（比值比，1.36；95%CI，1.17 至 1.58）需要后续治疗的可能性最高，其次是血管外科医生（比值比，1.06；95%CI，0.97 至 1.14），而普通外科医生最低。
结论：初始 PD 导管放置后需要后续治疗的可能性因操作人员的专业领域而异，介入科医生的可能性最高，普通外科医生的可能性最低。
