Streamlining Preoperative Evaluation for Dialysis Access: A Pilot Study

Area of Science:

• Vascular Surgery
• Nephrology
• Health Services Research

Background:

• Standard hemodialysis (HD) access creation involves an in-person clinic evaluation.
• Preoperative assessment for first-time access surgery complexity can often rely on patient history.
• This study evaluates a streamlined preoperative screening process for dialysis access.

Purpose of the Study:

• To compare outcomes of first-time arteriovenous fistula creation using a telephone screening versus a standard in-person clinic visit.
• To assess the feasibility and safety of a preoperative phone interview for dialysis access surgery.
• To determine if a non-in-person preoperative evaluation impacts surgical outcomes or access patency.

Main Methods:

• Patients scheduled for first-time dialysis access underwent a standardized telephone interview.
• Eligible patients opting for the telephone screen (SPEEDY group) proceeded to surgery without an in-person visit.
• Outcomes including time to surgery, fistula patency, and complication rates were compared to a control group receiving standard care.

Main Results:

• The SPEEDY group experienced a significantly shorter median time from referral to surgery (48 days vs. 82 days).
• No significant differences were observed in overall access patency rates or complication incidence between the groups.
• Eligible patients in the SPEEDY group were younger on average, but HD duration was similar.

Conclusions:

• A standardized telephone questionnaire can safely identify suitable candidates for first-time dialysis access surgery.
• This telephone screening approach significantly reduces the time from referral to surgery.
• The method avoids increased complications and does not compromise access patency rates.