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Risk factors for early peritoneal dialysis catheter failure in children
Randolph K Cribbs1, Larry A Greenbaum, Kurt F Heiss
1Division of Pediatric Surgery, Department of Surgery, Emory University, Atlanta, GA 30322, USA.
Insights
Omentectomy during pediatric peritoneal dialysis (PD) catheter placement reduces early catheter failure. Younger patients and those without omentectomy experienced higher failure rates, highlighting surgical technique importance for PD catheter longevity.
Area of Science:
- Pediatric Surgery
- Nephrology
- Medical Device Technology
Background:
- Optimal surgical techniques for pediatric peritoneal dialysis (PD) catheter placement remain unclear.
- Factors like operative approach, catheter choice, and patient characteristics may impact PD catheter lifespan.
Purpose of the Study:
- To investigate factors influencing early functional outcomes of surgically placed PD catheters in children.
- To identify surgical techniques and patient variables associated with PD catheter survival.
Main Methods:
- Retrospective review of 121 PD catheters placed in 81 pediatric patients over a 6-year period.
- Primary outcome: catheter function at 2 months post-placement.
- Statistical analysis using Student's t-test and chi-squared analysis.
Main Results:
- Median functional catheter survival was 109 days, with 30% experiencing primary failure within 2 months.
- Younger patients (8 years) had significantly higher rates of primary catheter failure compared to older patients (12 years).
- PD catheters placed without simultaneous omentectomy showed increased likelihood of failure (P = .042).
Conclusions:
- Performing omentectomy during PD catheter placement significantly reduces the risk of early catheter failure in pediatric patients.
- Catheter type and laparoscopic placement techniques did not significantly affect early functional outcomes.
- Omentectomy is a critical surgical consideration for improving PD catheter longevity in children.
Background:
There is uncertainty regarding the optimal approach for surgical placement of peritoneal dialysis (PD) catheters in children. Operative technique, catheter selection, and patient variables (eg, age or prior surgical history) may influence catheter lifespan.
Methods:
A retrospective review of all PD catheters placed at a tertiary children's medical center during a 6-year period was performed. Our primary outcome was catheter function 2 months after placement. Data were analyzed using Student 2-tailed t test or chi(2) analysis.
Results:
There were 121 PD catheters placed in 81 patients. The median primary functional catheter lifetime was 109 days. Primary PD catheter failure (within 2 months) occurred in 36 catheters (30%). Patients with primary catheter failure (8 +/- 7 years) were younger than patients with a functioning catheter at 2 months (12 +/- 5 years; P = .002). Catheters placed without simultaneous omentectomy were more likely to fail (P = .042). Catheter failure rate was not significantly different based upon operative technique or catheter type.
Conclusion:
Omentectomy at the time of catheter placement decreased the risk of early catheter failure. In contrast, type of catheter or laparoscopic placement did not influence the likelihood of early catheter failure.
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