A multidisciplinary approach to hemodialysis access: Prospective evaluation
A multidisciplinary approach to hemodialysis access: Prospective evaluation
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DOI：
10.1046/j.1523-1755.1998.00761.x
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发表时间：
1998-02-01
影响因子：
19.6
通讯作者：
Zeigler, ST
中科院分区：
文献类型：
--
作者：
Allon, M;Bailey, R;Zeigler, ST
透析准入程序和并发症是慢性透析患者发病、住院和费用的主要原因。为了改善结果并降低血液透析准入程序的成本，我们开发了一种多学科方法，包括肾病学家、准入外科医生和放射科医生。一名全职透析准入协调员与外科医生和放射科医生一起安排所有准入程序，并跟踪结果。建立了一个计算机化数据库，以便对手术和并发症进行前瞻性记录。定期向外科医生和放射科医生提供机密、详细的分析和改进建议。多学科方法引起的主要变化如下：(1)凝块移植物的方法从住院外科手术发展到门诊放射治疗。移植术后即刻技术成功率从48%上升到69%。(2)选择性地植入动静脉（a - v）移植物从三天的住院治疗演变为基本上是门诊手术。当日手术或门诊手术的A-V移植比例从16%增加到81%。(3)新型A-V移植手术的手术并发症从25%下降到11%。(4)积极发现和纠正移植物狭窄可使移植物血栓发生率降低60%，从0.70例/患者/年降至0.28例/患者/年。(5)新透析患者自行造A-V瘘的比例由33%上升至69%。综上所述，综合多学科入路可显著减少通路手术并发症，减少通路失败。尽管因就诊而住院的人数明显减少，但仍取得了这些改善，节省了大量费用。
Dialysis access procedures and complications represent a major cause of morbidity, hospitalization and cost for chronic dialysis patients. To improve outcomes and reduce the cost of hemodialysis access procedures we developed a multidisciplinary approach, involving nephrologists, access surgeons, and radiologists. A full-time dialysis access coordinator scheduled all access procedures with the surgeons and radiologists, and tracked outcomes. A computerized database was developed for prospective documentation of procedures and complications. Confidential, detailed analyses and recommendations for improvements were provided periodically to the surgeons and radiologists. The major changes arising from the multidisciplinary approach were as follows: (I) The approach to clotted grafts evolved from an inpatient surgical procedure to an outpatient radiologic procedure. The immediate technical success rare of graft declots increased from 48% to 69%. (2) Elective placement of arteriovenous (A-V) grafts evolved from a three-day inpatient hospitalization to a largely outpatient procedure. The proportion of A-V grafts placed as same day surgery or outpatient surgery increased from 16% to 81%. (3) Surgical complications of new A-V graft surgery decreased from 25% to 11%. (4) Aggressive detection and correction of graft stenosis decreased the incidence of graft thrombosis by 60%, from 0.70 to 0.28 events per patient-year. (5) The proportion of native A-V fistula construction in new dialysis patients increased from 33% to 69%. In conclusion, an integrated multidisciplinary approach markedly reduced surgical complications of access surgery and decreased access failures. These improvements occurred despite a marked decrease in hospitalization for access procedures, with a substantial cost saving.