SS20 - Factors Associated with Cancellation of Arteriovenous Access Cases

Saturday, June 7, 2025

11:27 AM – 11:38 AM CT

Location: Morial CC, Second Floor, Room 208-210

Presenting Author only(s)

Andrea Alonso, MD

Surgery Resident
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts

Slides

Senior Author Discussant(s)

Jeffrey J. Siracuse, MD, MBA

Professor of Surgery and Radiology, Chief of Vascular and Endovascular Surgery
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts

Co-Author(s)

JH

Jingtong Huang

Boston University Chobanian and Avedisian School of Medicine
CF

Carlos Fairen Oro

Boston University Chobanian and Avedisian School of Medicine
KM

Khu Aten Maaneb De Macedo

Surgery Resident
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts
Jeffrey A. Kalish

Associate Professor of Surgery and Radiology
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts
AF

Alik Farber, MD, MBA

Professor of Surgery
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts
EK

Elizabeth King-Paulson, MD
VC

Vipul Chitalia

Objectives: Cancellation of arteriovenous (AV) access creation delays establishing permanent hemodialysis access, potentially affecting patient outcomes and healthcare efficiency. Our goal was to assess the rate of AV access cancellations and identify contributing factors.

Methods: All AV access creations at a single academic medical center (2018- 2024) were retrospectively reviewed. Reasons for outpatient and inpatient AV access creation cancellations on the planned day of and the week before were analyzed. Multivariable analysis of same day outpatient cancellations was also performed.

Results: There were 582 patients who were scheduled for an AV access creation, of which 17.7% had same day cancellations and 7.6% had a cancellation the week before. The most common same day reasons for cancellations were acute illness (21.4%), hyperkalemia (11.7%), scheduling issues (11.7%), patient not showing up (11.7%), and fluid overload or uncontrolled hypertensive (9.7%) (Table). The most common week before cancellations were due to patient’s declining surgery (22.7%), acute illness (18.2%), incomplete medical clearance (18.2%), and scheduling issues (11.4%) (Table). On multivariable analysis, same day outpatient cancellations were significantly associated with an afternoon case start time (OR 3.09, 95% CI 0.75-2.37, P<.001).

The median time to AV access creation following a cancellation was 32 days. However, among same day cancellations, 14.3% did not proceed with permanent HD access within 6 months, and 7% required an interval tunneled dialysis catheter (TDC). Among week before cancellations, 16.7% did not proceed with permanent HD access within 6 months, and 4.7% required an interval TDC.

Conclusions: Cancellations of AV access creations affected a quarter of scheduled cases. Acute illness, poor control of renal disease-related complications, and logistical factors were among the most common reasons for cancellations, highlighting potential areas for targeted improvement. Efforts to address these factors, particularly by optimizing scheduling and pre-operative preparation, may reduce cancellations and new catheter placements, and may improve the timeliness of definitive AV access creation.