Abstract:
BACKGROUND:As high healthcare costs are increasing scrutinized, a movement toward reducing patient hospital admissions and lengths of stay has emerged, particularly for operations that may be performed safely in the outpatient setting. Our aim is to describe recent temporal trends in the proportion of dialysis access procedures performed on an inpatient versus outpatient basis and to determine the effects of these changes on perioperative morbidity and mortality. METHODS:The 2005-2008 American College of Surgeons National Surgical Quality Improvement Program database was queried for all primary arteriovenous fistula (AVF) procedures using current procedural terminology codes. Changes in the proportions of inpatient versus outpatient operations performed by year, as well as the associated 30-day postoperative morbidity and mortality, were analyzed using univariable statistics and multivariable logistic regression. RESULTS:Two thousand nine hundred fifty AVF procedures were performed over the study period. Overall, 71.7% (n = 2,114) were performed on an outpatient basis. Inpatient procedures were associated with higher 30-day morbidity (10.5% vs. 4.5%) and mortality (2.8% vs. 0.7%) than outpatient procedures (both, P < 0.001). There was a significant increase in the proportion of procedures performed on an outpatient basis over time (2005: 56% vs. 2008: 75%; P < 0.001). There were no changes in postoperative morbidity or mortality for inpatient or outpatient AVF over time (P ≥ 0.36). Independent determinants of having an inpatient procedure included younger age (OR 0.99), increasing ASA class (ASA IV OR 1.56), congestive heart failure (OR 3.32), recent ascites (OR 3.25), poor functional status (OR 3.22), the presence of an open wound (OR 1.91), and recent sepsis (OR 6.06) (all, P < 0.01). Acute renal failure (OR 2.60) and current dialysis (OR 1.44) were also predictive (P < 0.001). After correcting for baseline differences between groups, the adjusted OR for both morbidity (aOR 1.93, 95% CI 1.38-2.69) and mortality (aOR 2.85, 95% CI 1.36-5.95) remained significantly higher for inpatient versus outpatient AVF. CONCLUSIONS:Dialysis access operations are increasingly being performed on an outpatient basis, with stable perioperative outcomes. Inpatient procedures are associated with worse outcomes, likely because they are reserved for patients with acute illnesses, serious comorbidities, and poor functional status. Overall, for appropriately selected patients, the movement toward performing more elective dialysis access operations on an outpatient basis is associated with acceptable outcomes.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Hicks CW,Bronsert M,Hammermeister KE,Henderson WG,Gibula DR,Black JH 3rd,Glebova NOdoi
10.1016/j.avsg.2017.07.032subject
Has Abstractpub_date
2018-01-01 00:00:00pages
65-74.e1eissn
0890-5096issn
1615-5947pii
S0890-5096(17)30947-0journal_volume
46pub_type
杂志文章abstract::From February 1985 through November 1988, we performed 159 transluminal angioplasty in 135 patients with arterial occlusive disease of the lower limb. The indications were claudication, 114 cases (72%) and limb salvage, 45 cases (28%). Lesions consisted of one or more critical stenoses in 142 cases (61 iliac, 69 femor...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)60832-7
更新日期:1990-11-01 00:00:00
abstract::Twenty-nine cases of post-traumatic false aneurysms and arteriovenous fistulas (AVF), with a mean follow-up of 24 months (1-65 months), are presented here. Diagnosis was established by color duplex and arteriogram. The time between injury and treatment varied between 3 days and 61 months. Endovascular treatment was ac...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900230
更新日期:1999-03-01 00:00:00
abstract:BACKGROUND:Abdominal aortic aneurysm (AAA) is a common and lethal disease. AAAs are associated with atherosclerosis, chronic inflammation, and extracellular matrix degradation. The aim of this study was to determine whether treatment with simvastatin can influence the development of experimental aortic aneurysms in a r...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.09.003
更新日期:2012-02-01 00:00:00
abstract::The need to treat an abdominal aortic aneurysm (AAA) in kidney transplanted patient is a rare event. To date, no method to protect the kidney during the aneurysm treatment has been identified as undeniably relevant. On the other hand, the advantage of endovascular treatment of the aneurysm (EVAR) is to avoid transplan...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.04.058
更新日期:2015-08-01 00:00:00
abstract::Duodenocaval fistula (DCF), an unusual pathology, is associated with a 40% mortality rate in the 36 patients previously reported. Although migrating or ingested foreign bodies, trauma, and peptic ulcer disease are often described etiologies, 11 patients have been described who developed DCF after resection of retroper...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/s10016-003-0097-8
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Off-label parallel endografting (PE) has been increasingly criticized in favor of on-label custom fenestrated endografts. There remain limited direct comparisons, however, between concurrent patient populations treated by similarly experienced operators. Hence, we seek to evaluate the relative efficacy of th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.09.009
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:This study examines the outcome of hybrid revascularization combining iliofemoral endarterectomy and iliac artery stenting using covered stents in TransAtlantic Inter-Society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD) involving the common femoral artery (CFA). METHODS:A retrospective revie...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.11.061
更新日期:2018-07-01 00:00:00
abstract::Open surgical repair of complex abdominal aortic aneurysms requires more extensive dissection and aortic clamping above the renal or mesenteric arteries. Although results of open surgical series have shown variation, morbidity and mortality is higher compared with infrarenal aortic aneurysm repair. Potential complicat...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2010.10.005
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:In this study, we sought to analyze emerging national trends in the treatment of lower extremity peripheral arterial disease and associated outcomes. METHODS:The Nationwide Inpatient Sample was queried between 2001 and 2007. Patients diagnosed with lower extremity atherosclerosis were selected by using the ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.08.006
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Carotid blowout syndrome is a severe complication of head and neck cancer, associated with high mortality and morbidity. METHODS:We present a case of acute hemorrhage from the carotid artery of a 59-year-old man with a history of chemoradiotherapy for lingual base and oropharyngeal squamous cell carcinoma. ...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.02.023
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:We report a rare case of severe spinal cord ischemia with neurological consequences in a patient who presented after endovascular treatment of a type II endoleak following endovascular aneurysm repair. METHODS AND RESULTS:An enlarging abdominal aortic aneurysm post-endovascular aneurysm repair was detected ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.12.018
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:Primary closure (PC) and patch angioplasty (PA) during carotid endarterectomy (CEA) have been disputed in many studies. Some studies announced that PC is associated with a higher restenosis rate. The aim of this study was to evaluate the outcomes of PC and PA using propensity score matching (PSM). METHODS:B...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.11.011
更新日期:2020-01-01 00:00:00
abstract::Longitudinal elasticities of whole human blood clot, whole canine blood clot, Factor XIII cross-linked fibrin, glutaraldehyde-fixed human albumin, and formaldehyde-fixed collagen, gelatin and collagen/gelatin were determined and normalized to human whole blood clot. Matrices of a knitted Dacron graft were then impregn...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02042732
更新日期:1992-03-01 00:00:00
abstract:BACKGROUND:The aim of this study was to evaluate the vascular injuries, repairs, and complications encountered during anterior thoracolumbar spine exposures. METHODS:The medical records of patients undergoing anterior spine exposures from January 2004 to June 2010 were retrospectively analyzed. RESULTS:A total of 269...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.04.023
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:Diabetes mellitus is a major risk factor for progression to lower extremity amputation (LEA) due to progressive neuropathy and glycemia-induced vasculopathy. In this study, we evaluated risk factors for incident LEA type 2 diabetics during a randomized controlled trial and extended post-trial follow-up. MET...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.10.022
更新日期:2020-11-26 00:00:00
abstract:BACKGROUND:To propose a protocol for the routine clinical use of duplex ultrasound (DUS) assessment after transcarotid artery revascularization (TCAR) procedures, with its specific point of vascular access, based on DUS data from routine clinical practice. METHODS:DUS data were retrospectively collected at 2 centers f...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.09.065
更新日期:2020-11-24 00:00:00
abstract::Traditional methods for revascularization of an occluded aortoiliac system have necessitated either in-line aortic reconstruction through an aortobifemoral bypass or extra-anatomic bypass. However, both these approaches require artificial material to be placed in the groin. The consequence of groin infection can be de...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.09.023
更新日期:2011-04-01 00:00:00
abstract::Aortic wall tension was determined in 40 patients to assess its predictive value in abdominal aortic aneurysm (AAA) rupture. A 3-year retrospective analysis of 243 patients with ruptured AAAs and 45 patients with intact AAAs was conducted. The 288 patient sample was limited to the 40 patients with an abdominal CT scan...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169910027
更新日期:2000-03-01 00:00:00
abstract::We report the endovascular management of a patient with a type B aortic dissection complicated by renal ischemia and resultant severe hypertension. A 69-year-old male presented with acute type B aortic dissection with proximal extension complicated by severe renovascular hypertension secondary to left renal ischemia. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-001-0184-7
更新日期:2002-05-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to quantify and evaluate the expression response of miRNA-191 and miRNA-455-3p endovascular repair of abdominal aortic aneurysm (AAA) based in whole blood samples. METHODS:This report describes a prospective study of a single center of 30 patients with AAA who underwent endovas...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.01.086
更新日期:2018-07-01 00:00:00
abstract::Aortic iatrogenic injuries during spinal instrumentation are rare but carry a high risk of mortality. In this report, we describe the case of a 26-year-old man with traumatic vertebral fracture and subsequent spinal cord injury who underwent posterior vertebral fixation at our trauma center. The neurosurgical procedur...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.01.007
更新日期:2020-07-01 00:00:00
abstract::Between 1985 and 1988 45 patients with descending thoracic or thoracoabdominal aortic aneurysms underwent selective arteriography of the intercostal and lumbar arteries to delineate preoperatively the artery of Adamkiewicz and the thoracic radicular artery. Identification of these vessels failed in five patients (11%)...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)62382-0
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:In a number of relatively small-size studies, investigators have measured and compared circulating interleukin-6 (IL-6) levels in cases with abdominal aortic aneurysm (AAA) and controls without AAA to assess its possible role in the pathogenesis or progression of AAA. To summarize the present evidence for an...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.avsg.2014.06.058
更新日期:2014-11-01 00:00:00
abstract::We prospectively evaluated all patients with superficial foot necrosis of 1-3 cm and transcutaneous oxygen tension (TcPO2) values of <30 mmHg who received a sympathectomy as the primary treatment of their vascular occlusive disease. Preoperatively, and every 2-3 days in the postoperative period, measurement of TcPO2 o...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900118
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND:Hepatocellular carcinoma (HCC) with tumor thrombus (TT) in hepatic vein, inferior vena cava (IVC), and right atrium (RA) portends a poor prognosis because of intravascular extension leading to rapid distal metastases. En bloc resection of cavoatrial TT without the use of cardiopulmonary bypass (CPB) is chall...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.02.021
更新日期:2014-08-01 00:00:00
abstract::We report a case of secondary rupture of a common iliac artery aneurysm into the common iliac vein. Exclusion of the iliac aneurysm had been performed 2 years earlier in association with reconstruction of an aortic aneurysm that had ruptured into the interior vena cava. After closure of the aortocaval fistula by the e...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02001897
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Iodine contrast medium (ICM) is considered to be gold standard in endovascular procedures, but its nephrotoxicity and hypersensitivity limit the widespread use. Carbon dioxide (CO2) is considered as an alternative for endovascular procedures in patients with contraindication to ICM. However, no studies have ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.avsg.2016.06.028
更新日期:2017-02-01 00:00:00
abstract::Supracoeliac abdominal aortic dissections are rare and require complex interventions for repair. Superior mesenteric artery (SMA) dissections are also rare and even less frequently reported to involve aneurysmal change. We present the case of a 65-year-old man with a dissecting supracoeliac aortoiliac aneurysm and a s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2014.07.021
更新日期:2014-11-01 00:00:00
abstract::Because of limited longevity and perceived increased perioperative risk, the optimal treatment of significant carotid stenosis in nonagenarians is controversial. This study was conducted to evaluate our results in this demographic group. A retrospective review was performed of carotid endarterectomies (CEAs) done in n...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2007.12.001
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:The safety and efficacy of right axillary cannulation during complex aortic aneurysm repair for the deployment of chimney grafts is controversial, however there are few studies that compare right and left upper extremity access . We favor the right axillary approach because of the relative ease of access to t...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.10.028
更新日期:2020-11-26 00:00:00