Abstract: PUB137
Trends and Outcomes in Open vs. Laparoscopic Peritoneal Dialysis Catheter Placement from 2013 to 2018
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Shah, Ankur, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Hu, Susie L., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Raker, Christina A., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
Background
Patients receiving dialysis require a durable access to the bloodstream for hemodialysis or peritoneal cavity for peritoneal dialysis. In peritoneal dialysis, the catheter can be placed via a percutaneous or surgical approach, With the surgical approach being open or laparoscopic. The purpose of our study is to demonstrate in the modern era in a nationwide, US cohort the trends and outcomes associated with laparoscopic versus open PD catheter insertion.
Methods
We conducted a retrospective analysis using NSQIP database from January 1, 2013, to December 31, 2018. Patients undergoing peritoneal dialysis catheter placement were identified using relevant Current Procedural Terminology (CPT) codes. Data on patient characteristics, surgical approach and operative characteristics, and perioperative outcomes were extracted. Trends in the proportion of open versus laparoscopic techniques were analyzed over the study period.
Results
A total of 11,732 patients who underwent peritoneal dialysis catheter placement were included in the analysis. The proportion of laparoscopic techniques increased steadily from 76.1% in 2013 to 86.8% in 2018, while the proportion of open techniques showed a corresponding decline. Statistical analysis revealed a significant temporal trend towards a higher utilization of laparoscopic catheter placement (p<0.001). Mortality was greater for open insertion compared to laparoscopic (odds ratio (OR) 1.56, 95% Confidence Interval (CI) 1.03 – 2.36, p = 0.04). There was no difference in surgical site infection (OR 1.25, 95% CI .97 – 1.73, p = 0.18), transfusion (OR .89, 95% CI .6 – 1.31, p = 0.55), or sepsis (OR 1.04, 95% CI .67 – 1.6, p = 0.87).
Conclusion
This study provides insights into the temporal trends in open versus laparoscopic peritoneal dialysis catheter placement using a large national database. Our findings indicate a substantial shift towards laparoscopic techniques over the study period. While we found open catheter placement to be associated with higher mortality, we believe this is due to confounding by indication and residual confounding. These findings contribute to the growing body of evidence on the evolving trends in peritoneal dialysis catheter placement and have implications for surgical decision-making and healthcare resource planning.
Funding
- Clinical Revenue Support