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• W4384831908 abstract "Objectives Functional impairment affects outcomes after a variety of procedures. However, the impact of functional impairment on outcomes of arteriovenous (AV) access creation is unclear. We aimed to evaluate the association of patients’ ability to ambulate and perform activities of daily living (ADL) with AV access outcomes. Methods We retrospectively reviewed patients undergoing AV access creation at an urban, safety-net hospital from 2014-2022. We evaluated associations of impaired ambulatory and assisted ADL status with 90-day readmission, 1-year primary patency, and 5-year mortality. Results Among 689 patients receiving AV access, mean age was 59.6 ± 13.9 years, 59% were male, and 60% were Black. Access types included brachiocephalic (42%), brachiobasilic (26%), radiocephalic (14%), other autogenous (5%) fistulas and prosthetic grafts (13%). Impaired ambulatory status was identified in 35% and assisted ADL status, when assessed, was identified in 21% of patients. Ninety-day readmission was more likely in patients with impaired ambulatory (58% vs. 39%, P<.001) and assisted ADL (56% vs. 41%, P=.004) status. On Kaplan-Meier analysis, 1-year primary patency was lower for patients with impaired ambulatory status (44% ± 3% vs. 29% ± 3%, P=.001), but was not significantly different for patients with assisted ADL status (41% ± 3% vs. 32% ± 5%, P=.12). Five-year survival was lower for patients with impaired ambulatory status (53% ± 5% vs. 74% ± 4%, P<.001), but was not significantly different for patients with assisted ADL status (45% ± 9% vs. 71% ± 4%, P=.1). On multivariable analysis, increased likelihood of 90-day readmission was significantly associated with impaired ambulatory status (OR 2.03, 95% CI 1.4-2.94, P<.001) and assisted ADL status (OR 1.66, 95% CI 1.07-2.57, P=.02). One-year primary patency was not significantly associated with impaired ambulatory (HR 1.25, 95% CI .98-1.6, P = .07) or assisted ADL status (HR 1.13, 95% CI .87-1.48, P=.36). Increased likelihood of 5-year mortality was associated with impaired ambulatory (HR 1.65, 95% CI 1.04-2.62, P=.04) and assisted ADL status (HR 2.63, 95% CI 1.35-5.11, P=.004). Conclusions Impaired ambulatory and assisted ADL status were associated with increased readmissions and long-term mortality after AV access creation. Approximately half of patients with functional impairment were not alive at 5 years. Setting outcome expectations as well as prospectively examining the impact of physical therapy and visiting nursing services for functionally impaired patients undergoing AV access creation are warranted." @default.
• W4384831908 created "2023-07-21" @default.
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• W4384831908 date "2023-07-01" @default.
• W4384831908 modified "2023-10-12" @default.
• W4384831908 title "Functional Impairment is Associated with Poor Long-Term Outcomes after Arteriovenous Access Creation" @default.
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• W4384831908 doi "https://doi.org/10.1016/j.avsg.2023.07.088" @default.
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