Many Surgeons Still Performing Inappropriate Vascular Access Sx
WEDNESDAY, June 19, 2019 -- For patients with first-time permanent hemodialysis access placement, more than one-fifth of surgeons have arteriovenous graft (AVG) use rates exceeding the recommended best practice guideline of 34 percent, according to a study published online June 12 in JAMA Surgery.
Caitlin W. Hicks, M.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues used inpatient and outpatient Medicare claims data to examine practice patterns and physician characteristics associated with high AVG versus arteriovenous fistula (AVF) use. Data were included for 85,320 patients who underwent first-time hemodialysis access placement, of whom 77.9 and 22.1 percent had an AVF and an AVG, respectively.
The researchers found that the median surgeon level AVG use rate was 18.2 percent for the 2,397 surgeons who performed more than 10 procedures per year. Overall, 20.8 percent of surgeons had an AVG rate >34 percent. Surgeon factors that were independently associated with AVG use included more than 30 years of clinical practice versus 21 to 30 years, metropolitan setting, and vascular surgery specialty versus general surgery after accounting for patient characteristics. The lowest rate of AVG use was seen among surgeons in the Northeast region (odds ratio, 0.83).
"We propose that sharing benchmarked performance data with surgeons could be an actionable step in achieving more high-value care in hemodialysis access surgery," the authors write.
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Posted: June 2019
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