Peritoneal Dialysis Catheter Complications after Insertion by Surgeons, Radiologists, or Nephrologists

Abstract

Background: The US government has implemented incentives to increase the use of peritoneal dialysis (PD). Successful placement of PD catheters is an important step to increasing PD utilization rates. Our objective was to compare initial outcomes after PD catheter placement by different types of operators. Methods: We included PD-naïve patients insured by Medicare who had a PD catheter inserted between 2010-2019. We examined the association between specialty of the operator (general surgeon, vascular surgeon, interventional radiologist, or interventional nephrologist) and odds of needing a follow-up procedure, which we defined as catheter removal, replacement, or revision within 90 days of the initial procedure. Mixed logistic regression models clustered by operator were used to examine the association between operator type and outcomes. Results: We included 46,973 patients treated by 5,205 operators (71.1% general surgeons, 17.2% vascular surgeons, 9.7% interventional radiologists, 2.0% interventional nephrologists). 15.5% of patients required a follow-up procedure within 90 days of the initial insertion, of whom 2.9% had a second PD catheter implanted, 6.6% underwent PD catheter removal, and 5.9% had a PD catheter revision within 90 days of the initial insertion. In models adjusted for patient and operator characteristics, the odds of requiring a follow-up procedure within 90 days were highest for interventional nephrologists (HR 1.86; 95% CI 1.56-2.22) and interventional radiologists (OR 1.36; 95% CI 1.17-1.58) followed by vascular surgeons (OR 1.06; 95% CI 0.97-1.14) compared with general surgeons. Conclusions: The probability of needing a follow-up procedure after initial PD catheter placement varied by operator specialty and was higher for interventionalists and lowest for general surgeons.

Prioritizing Skills for Optimal Peritoneal Dialysis Care: A Focus Beyond Specialty

“…In a recent study by Ku et al , examining 90-day outcomes after peritoneal dialysis (PD) catheter placement in a cohort of nearly 50,000 patients, the impact of operator specialization was the focal point. 1 Notably, PD catheters inserted by nongeneral surgeons, particularly interventional nephrologists, were associated with a significantly higher likelihood of requiring follow-up procedures (odds ratio, 1.86). However, it is critical to acknowledge the study's inherent limitations.…”

Authors' Reply: Prioritizing Skills for Optimal Peritoneal Dialysis Care: A Focus Beyond Specialty

“…We also note that Figure 2 in the manuscript shows operator-level probability of a second procedure and does provide an overview of the spread of the probability of complication rates across individual operators included in our study. 2 We have now provided a simplified boxplot in Figure 1, where it does not appear that a few select operators influenced the results and "unduly obscured the capabilities of their peers." There were 106 interventional nephrologists included in our study who collectively performed nearly 1400 procedures, and the complication rate of most interventional nephrologists was higher than other specialties.…”

Of Peritoneal Dialysis Access and Home Dialysis Accessibility

“…1 In this issue of JASN, Ku and colleagues use Medicare claims and United States Renal Data System data to explore the association between the specialty of the operator (categorized as vascular surgery, general surgery, interventional radiology, or interventional nephrology) and the risk of requiring a follow-up procedure within 90 days among adult PD-naïve, Medicare-insured individuals whose PD catheter was placed between 2010 and 2019. 2 Follow-up procedures were defined as PD catheter revision, replacement, or removal; the use of PD at 90 days was also explored. Percutaneous, laparoscopic, and open dissection methods were all included.…”