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Hemodialysis Access Creation In The Digital Age: Is Preoperative Evaluation Via Telemedicine A Viable Alternative To In-person Office Visits?
Maha H. Haqqani, MD1, Grace Kennedy, MD
1, Simran Patwa, BS
1, Danielle Bajakian, MD
1, Roman Nowygrod, MD
1, Thomas F.X. O'Donnell, MD
1, Virendra I. Patel, MD, MPH
1, Jeffrey J. Siracuse, MD, MBA
2, Nicholas J. Morrissey, MD
1.
1Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA,
2Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
OBJECTIVES: We sought to evaluate the feasibility of telemedicine visits for patients being evaluated for hemodialysis (HD) access creation.
METHODS: A retrospective chart review was performed of patients aged >18 who underwent virtual telemedicine-only (TELE) and in-person (OFFICE) preoperative evaluations for HD access creation (October 2020 to December 2024) at a single tertiary center. Preoperative and intraoperative characteristics were determined. Access utilization, and open and percutaneous interventions at 1-year, were assessed.
RESULTS: 41 TELE and 271 OFFICE patients were identified. Mean age was similar between TELE (64.2 ± 13.1 years) and OFFICE groups (62.3 ± 15.3,
P=0.45). TELE patients were less likely to have heart failure (34.1% vs 66.8%,
P<0.001), but diabetes (61% vs. 57%), deep vein thrombosis/pulmonary embolism (9.8% vs. 11.1%), hypertension (97.6% vs. 95.6%), coronary artery disease (26.8% vs. 26.9%), peripheral arterial disease (14.6% vs. 13.7%) were similar (
P>0.5 for all). Prior arteriovenous fistula (AVF) or graft (AVG) rates were comparable (12.2% vs. 18.1%,
P=0.17).
9.8% of TELE patients underwent preoperative vein mapping, compared to 53.9% OFFICE patients (
P<0.001). The majority in both groups underwent creation on planned side (97.6% vs. 97.1%,
P=0.43). For TELE, the most common operations were brachiobasilic (34.1%), brachiocephalic (31.7%) AVF, brachial-axillary AVG (17.1%), and radiocephalic AVF (14.6%); OFFICE patients most commonly received brachiobasilic (43.9%), radiocephalic (28.4%), and brachiocephalic (16.2%) AVF, followed by brachial-axillary (7.7%) and forearm loop AVG (7.4%)(
P=0.02). One TELE (2.4%) and seven OFFICE (2.6%) patients required 30-day reintervention for hematoma or steal (
P=0.47).
Of 25 TELE and 218 OFFICE patients with 1-year follow-up, 100% TELE and 83.5% OFFICE patients had started HD. Of these, 56% of TELE and 45.9% OFFICE patients were using their access at 1-year (
P=0.17); 1-year percutaneous reintervention rates were 44% for TELE vs. 31.2% for OFFICE (
P=0.09). Open revisions were more common in the TELE group, but this was not statistically significant (24% vs. 14.2%,
P=0.1). The relevant access had been abandoned by 1 year in 32% TELE and 37.2% OFFICE patients (
P=0.3).
CONCLUSIONS: Telemedicine visits before HD access creation may be a feasible option to help alleviate healthcare costs, increase accessibility, and improve adherence among patients for whom office scheduling is limited by HD sessions. While our results are promising, ongoing prospective data collection is needed to confirm these potential benefits.
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