Arteriovenous fistula creation and care in an office-based practice compared with hospital-based care

This study evaluates and compares outcomes of arteriovenous fistulas (AVFs) created in a dialysis access-dedicated office-based laboratory (OBL) and outpatient hospital setting.

All consecutive outpatient surgical autologous AVFs created at an academic hospital, community hospital, and an OBL from 2016 to 2020 were reviewed. Demographics, comorbidities, surgical procedure, complications, maturation, patency, and procedures for maintenance were assessed from time of surgical evaluation to the latest available documentation. Complications, maturation, and patency were compared by location of surgery and postoperative access-related care, creating three groups: surgery and follow-up in hospital (hospital group), surgery in hospital and follow-up in an OBL (hybrid group), or surgery and follow-up in OBL (OBL group).

We included 389 AVFs; 138 were in the hospital group, 125 in the hybrid group, and 126 in the OBL group. The median follow-up time was 34.7 months. The mean age was 59 years. Percentage of male patients was 58%. The three groups did not differ with respect to demographics and comorbidities. Peri-operative complication rate was 6.4% among 263 hospital outpatient procedures and 1.6% among 126 OBL procedures (P = .043). The maturation rate was lower in the hospital group (54%) than the hybrid (86%) and OBL (93%) groups, irrespective of AVF type (P < .001). The mean time to approval for use was 52 days in the OBL group, 66 days in the hybrid group, and 98 days in the hospital group (P < .001). The hospital group had the highest primary patency, but the lowest functional patency. During the follow-up period, there was a significant difference in number of procedures per year of functional patency, with 0.7 in the hospital group, 2.1 in the hybrid group, and 2.1 in the OBL group (P < .001).

Surgical AVF creation in a dialysis access-dedicated OBL is safe and associated with fewer perioperative complications, higher maturation rate, better functional patency, and lower time to approval for use as compared with patients receiving hospital-based care only. Similar results were seen among hospital created fistula patients who received subsequent care at an OBL. Dialysis access creation and care in AV Access dedicated OBLs is associated with improved outcomes as compared with hospital-based care.