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Impact of a multidisciplinary team approach upon patency rates of arteriove
Author(s) -
TREACY P John,
SNELLING Paul,
RAGG Joe,
CARSON Phillip,
O'ROURKE Ian
Publication year - 2002
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1046/j.1440-1797.2002.00089.x
Subject(s) - medicine , fistula , surgery , multidisciplinary team , diabetes mellitus , nursing , endocrinology
SUMMARY: A team approach to fistula surgery, with a weekly ward round and elective fistula list, was introduced at the Royal Darwin Hospital in April 1999. This study has evaluated the impact of this team approach and assessed factors influencing fistula patency. Data was prospectively recorded on all patients who underwent fistula surgery between 1993 and August 2000. Three hundred and forty‐seven operations were performed in 161 patients, with 142 (41%) for revision of an established fistula. One hundred and nine operations (m 79 patients) were performed after the onset of the team approach. A 30‐day fistula patency rate was significantly greater for new operations than revision operations, at 86 and 77% ( P = 0.047). Primary and secondary patency rates were 56 and 75%, respectively, at 1 year, and 38 and 42% at 3 years. Factors associated with reduced duration of fistula patency following any operation included operations before the team approach ( P =0.0002), operations out‐of‐hours ( P =0.020), use of an interposition graft ( P =0.035), and persons NOT of aboriginal race ( P =0.007). Diabetes was suggestive of reduced patency ( P =0.065). the only factor associated with reduced secondary patency was the use of an interposition graft ( P = 0.020). Factors not shown to influence primary or secondary patency included the artery or vein used, peripheral vascular disease, hypertension, cerebrovascular disease, and the particular surgeon who performed the operation. Out‐of‐hours surgery was reduced, from 37 to 28% by the dedicated theatre list We conclude that the team approach to fistula surgery, with a dedicated theatre list, prolongs fistula patency, plus allows the surgeon to steep at night. an interposition graft should be avoided whenever possible.