Octogenarians Have Similar Outcomes To Non-octogenarians After Upper Extremity Hemodialysis Access Creation
Quinten Dicken, Kristiana Sather, Alik Farber, Douglas Jones, Logan Mendez, Victor Castro, Yixin Zhang, Jeffrey Siracuse.
Boston University, Boston, MA, USA.
Introduction and Objectives: Arteriovenous (AV) access creation in octogenarians is a debated area with little evidence for guidance. Our goal was to assess perioperative and long-term outcomes in octogenarians after undergoing upper arm AV access.
Methods: We performed a retrospective single analysis from a single institution. Demographics, comorbidities, and AV access details were recorded. Groups were divided into octogenarians and non-octogenarians. Perioperative complications and long-term outcomes including access maturation (by surgeon assessment or successful use), occlusion, and re-intervention were evaluated.
Results: 40 octogenarians and 580 non-octogenarians were identified. Octogenarians were more likely to have private insurance, coronary artery disease, dementia, previous stroke, impaired ambulation, and be a non-current smoker. There were no differences in outpatient status or tunneled line presence at creation. Access type was similar - brachiocephalic (50% vs. 42.6%), brachiobasilic (12.5% vs. 26.2%), radiocephalic (12.5% vs. 14.3%), and grafts (25% vs. 13.8%) (P>.05). Univariable analysis showed no difference in perioperative hematoma, OR return, and patency loss. On multivariable analysis, octogenarians were associated with non-home discharge (OR 2.4, 95% CI 1.02 – 5.9, P = .045). There was no difference for 90 day survival (OR 0.46, 95% CI 0-2.5, P=.25), readmission within 90 days (OR 1.36, 95% CI 0.67-2.76, P = .39), maturation within 180 days (OR 0.97, 95% CI 0.46 – 2.01, P=.93) or reintervention (HR 0.9, 95% CI 0.64 – 1.25, P = .53). 2 year Kaplan-Meier analysis showed octogenarians had lower survival (82.5% vs. 91.9%, P<.001), with no difference in freedom from reintervention (55% vs. 47%, P=.47) or freedom from occlusion (25% vs. 24%, P=.62).
Conclusions: Octogenarians had similar outcomes compared to non-octogenarians even when accounting for access type in this mostly autogenous cohort. They were more likely to have non-
home discharge despite similar outpatient scheduling. Advanced age alone should not influence dialysis access creation.
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