Cost-Effective Day Surgery for Arteriovenous Fistula Stenosis: A Viable Model for Hemodialysis Patients.

Abstract

BACKGROUND For patients with end-stage renal disease, arteriovenous fistulas (AVFs) are often used for hemodialysis, but stenosis can impair their function. Traditional inpatient procedures to address AVF stenosis are effective but resource-intensive, prompting the need for alternative approaches like day surgery to optimize care and reduce costs. This study evaluated the feasibility of a day surgery model for AVF stenosis treatment in maintenance hemodialysis (MHD) patients, aiming to develop a cost-effective and high-quality care model. MATERIAL AND METHODS A prospective cohort study was conducted with 186 MHD patients undergoing AVF stenosis intervention between July 2022 and May, 2023. Patients were divided into a day surgery group (n=112) and a ward group (n=74). Various preoperative, intraoperative, and postoperative parameters were recorded, including AVF patency, complications, and rehospitalization rates. Follow-up assessments were conducted on postoperative days 1, 3, 7, and 30, with long-term patency evaluated at 6 and 12 months. RESULTS The day surgery group achieved a technical success rate of 99.11% and a complication rate of 3.57%, compared to 97.30% and 1.35% in the ward group. The day surgery group also had significantly shorter waiting times for beds, shorter hospital stays, and lower hospitalization costs (P<0.01). No significant differences were found between the groups in preoperative or postoperative parameters. CONCLUSIONS The day surgery model for AVF stenosis intervention in MHD patients is a viable option, showing comparable success and complication rates to inpatient surgery while significantly reducing hospital stays and costs.