Peritoneal Dialysis Catheter Complications after Insertion by Surgeons, Radiologists, or Nephrologists

Area of Science:

• Nephrology
• Surgical Outcomes
• Medical Device Placement

Background:

• The Advancing American Kidney Health Initiative seeks to increase peritoneal dialysis (PD) utilization in the U.S.
• Successful PD catheter placement is crucial for increasing PD use.
• Operator subspecialty may influence PD catheter outcomes.

Purpose of the Study:

• To compare initial outcomes of PD catheter placement based on operator subspecialty.
• To determine if PD catheter revision, removal, or re-implantation rates differ by the specialty of the performing physician.

Main Methods:

• Analysis of Medicare data for PD-naïve patients from 2010-2019.
• Inclusion of PD catheter insertions performed by general surgeons, vascular surgeons, interventional radiologists, and interventional nephrologists.
• Use of mixed logistic regression to assess the association between operator specialty and the need for a follow-up procedure within 90 days.

Main Results:

• 15.5% of PD catheters required a follow-up procedure within 90 days.
• Interventional nephrologists (OR 1.86) and interventional radiologists (OR 1.36) had significantly higher odds of requiring a follow-up procedure compared to general surgeons.
• Vascular surgeons showed no significant difference in follow-up procedure rates compared to general surgeons.

Conclusions:

• PD catheter placement outcomes are influenced by operator specialty.
• General surgeons had the lowest rates of follow-up procedures, while interventionalists had higher rates.
• Further investigation is needed to optimize PD catheter function across different operator types.