(PC230) Reintervention Rates and Costs Following Dialysis Access Placement: Insights from the Vascular Quality Initiative Database

Objectives: Arteriovenous fistula (AVF) and arteriovenous graft (AVG) maintenance require ongoing surveillance and multiple reinterventions, which impose substantial costs on the healthcare system. This study aimed to investigate the rates of open and endovascular reinterventions and the associated costs following access placement using real-world data.

Methods: Using VQI data (2019-2024), we analyzed adult patients undergoing upper extremity AVF/AVG placement with at least one follow-up visit. Primary outcomes were reintervention rates per 100 access placements and associated costs. Secondary outcomes included one-year reintervention, thrombosis, and mortality. We utilized negative binomial regression for reintervention counts and Gamma models for cost analysis, adjusting for demographics and comorbidities. Costs were estimated using relevant CPT codes. One-year outcomes were analyzed using Kaplan-Meier estimates and Cox regression models.

Results: A total of 18,983 accesses were studied (AVG=4,198, 22.1%). The median age of patients in the AVF and AVG cohorts was 63 (52, 72) and 66 (55, 75) years, respectively (P <.001). Patients in the AVG cohort were more likely to be female and African-American, and to have CAD and COPD. On the other hand, patients in the AVF cohort were more likely to be Hispanic/Latino, obese, and to have PAD. The mean follow-up was 470.6 days. Overall reintervention rates per 100 access placements were higher for AVGs compared to AVFs (58.33 vs. 53.23, P<.001), driven by endovascular procedures (23.96 vs. 17.03, P<.001). Mean costs per reintervention were significantly higher for AVGs compared to AVFs ($35,500 vs $29,500, P<.001). Total estimated costs per 100 accesses were $2.07 million for AVGs versus $1.57 million for AVFs (P <.001). At one year, AVG was associated with increased hazards of thrombosis (aHR=3.11, 95% CI, 2.70-3.57; P<.001), reintervention (aHR=1.27, 95% CI, 1.05-1.53; P=0.014), and mortality (aHR=1.46, 95% CI, 1.41-1.86; P=0.002) compared to AVF (Figure I).

Conclusions: Compared to AVFs, AVGs have higher reintervention rates and associated costs, as well as worse one-year outcomes. These findings underscore the importance of cost-conscious access planning. Further studies should evaluate the most cost-effective reinterventions for access maintenance.