Related Experiment Video
Updated: Sep 19, 2025
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Factors associated with cancellation of arteriovenous access creations
Andrea Alonso1, Jingtong Huang1, Carlos Fairen Oro1
1Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
Insights
Arteriovenous access cancellations delay hemodialysis, impacting patient care. Addressing acute illness, logistical issues, and preparation can reduce delays and improve outcomes for kidney disease patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Healthcare Management
Background:
- Arteriovenous (AV) access creation is crucial for permanent hemodialysis (HD) access.
- Cancellations of AV access procedures can lead to significant delays in establishing HD access.
- These delays may negatively impact patient outcomes and healthcare efficiency, particularly in safety net hospital settings.
Purpose of the Study:
- To determine the rate of AV access creation cancellations.
- To identify the primary factors contributing to these cancellations.
- To assess the impact of cancellations on subsequent HD access establishment and patient management.
Main Methods:
- Retrospective review of AV access creations at an academic medical center (2018-2024).
- Analysis of cancellation reasons for outpatient and inpatient procedures scheduled on the day and week prior.
- Multivariable analysis to identify predictors of same-day outpatient cancellations.
Main Results:
- 17.7% of AV access creations were cancelled on the same day, and 7.7% were cancelled the week before.
- Common cancellation reasons included acute illness, chronic kidney disease complications, logistical issues, and inadequate preparation.
- Same-day outpatient cancellations were associated with afternoon start times (OR, 3.09; P < .001).
- A significant proportion of patients (14.3% same-day, 16.7% week-before) did not receive permanent HD access within 6 months post-cancellation, with some requiring temporary catheters.
Conclusions:
- Cancellations affect approximately one-quarter of scheduled AV access procedures.
- Key factors contributing to cancellations include acute illness, poorly controlled CKD complications, and logistical challenges.
- Targeted interventions like scheduling optimization and enhanced preoperative preparation are recommended to reduce cancellations and improve hemodialysis care quality.
Objective:
Cancellation of arteriovenous (AV) access creation delays establishing permanent hemodialysis (HD) access, potentially affecting patient outcomes and health care efficiency. Our goal was to assess the rate of AV access cancellations and identify contributing factors in a safety net hospital.
Methods:
All AV access creations at a single academic medical center (2018-2024) were retrospectively reviewed. Reasons for outpatient and inpatient AV access creation cancellations on the planned day and week scheduled were analyzed using chart review. A multivariable analysis was performed to assess for predictors of same-day outpatient cancellations.
Results:
There were 584 patients who were scheduled for an AV access creation during the study period. Of these, 17.7% had same-day cancellations, and 7.7% had week-before cancellations. The most common reasons for same-day cancellation were acute illness (21.4%), chronic kidney disease-related complications (21.4%), logistical issues (11.7%), and inadequate preoperative preparation (13.6%). The most common reasons for cancellations 1 week before scheduled operation were patient choice (22.7%) acute illness (20.5%), inadequate preoperative preparation (20.5), and logistical issues (11.4%). On multivariable analysis, same-day outpatient cancellations were significantly associated with an afternoon case start time (odds ratio, 3.09; 95% confidence interval, 0.75-2.37; P < .001). The median time to AV access creation following a cancellation was 32 days. However, among same-day cancellations, 14.3% of patients did not proceed with permanent HD access within 6 months, and 7% required an interval tunneled dialysis catheter. Among week-before cancellations, 16.7% did not proceed with permanent HD access within 6 months, and 4.7% required an interval tunneled dialysis catheter.
Conclusions:
Cancellations of AV access creations affected one-quarter of scheduled cases, with several patients not proceeding with permanent HD access by 6 months. Acute illness, poor control of chronic kidney disease-related complications, and logistical factors were among the most common reasons for cancellations, highlighting potential areas for targeted improvement. Targeted efforts such as scheduling optimization and improved preoperative preparation may help reduce surgical cancellations and prevent unnecessary catheter placements. These interventions are also likely to enhance the overall quality of HD care for patients.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:26Cardiac Catheterization IV: Nursing Management
01:24Hemodialysis II: Procedure and Complications
01:19Anastomoses
Anastomoses can be formed at arterial, venous, and lymphatic vessels.
Arterial Anastomosis: These occur between arteries. They...