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IN FOR DIALYSIS, OUT FOR PERITONITIS: USE OF PERITONEAL DIALYSIS CATHETERS AND SPECTRUM OF COMPLICATIONS IN THE UNITED STATES
Sai Krishna Bhogadi
*, David Bittenbinder, Imazul Qadir, Matthew Holt, Ahmad B. Abdulkarim, Stephen W. Behrman
Surgery, Baptist Memorial Hospital-Memphis, Memphis, TN
Introduction: Peritoneal dialysis catheters (PDC) are a commonly preferred option for dialysis, being increasingly adopted due to their ease of use. However, there is limited large scale data on the extent of complications of PDC. This study aims to assess the outcomes of PDC on a nationwide scale.
Methods: All patients who underwent inpatient PDC placement in the first three months of each year from 2018 – 2020 were identified using the nationwide readmissions database (NRD) and were followed for the next 9 months. Patients who died during the index admission were excluded. Patients were stratified based on method of placement into open (O), laparoscopic (L), and percutaneous (PC) groups. The outcome measures were rates of catheter functional complications (leakage, mechanical breakdown, displacement), peritonitis, bowel obstruction, and PDC removal within 9 months of placement. Multivariable logistic regression (MLR) analyses were performed.
Results: A total of 7,284 patients were included in the study (O 16.5%, L 59.2%, PC 24.3%). The mean age was 52 years. The 9-month readmission rate was 51.7%. The rates of overall complications were 16.4%. Nearly 6.8% (n = 496) developed functional complications, 11.1% (n = 812) developed peritonitis, 1.4% (n = 103) suffered bowel obstruction, and 10% (n = 729) underwent catheter removal within 9 months. An increasing rate of complications with time was observed (4.2% peritonitis at 1 month vs 11.1% at 9 months; 0.7% bowel obstruction at 1 month vs 1.4% at 9 months, 4.2% removal at 1 month vs 10% at 9 months). L group had higher rates of functional complications, peritonitis, and removal, whereas PC group had highest rates of bowel obstruction (
Table 1a). On MLR, laparoscopic placement was associated with the highest odds of functional complications, peritonitis, and removal, whereas it was associated with lower odds of bowel obstruction compared to open placement (
Table 1b).
Conclusion: Nearly one-third of readmissions in renal failure patients undergoing PDC placement may be attributable to complications related to the PDC itself. Peritonitis is a clinically significant complication in patients undergoing PDC placement, with nearly 1 in 10 developing peritonitis at 9 months resulting in removal of catheter. Bowel obstruction, while uncommon, is a concern particularly among patients undergoing open or percutaneous placement. Results of this study are important for patients to make informed decisions. Comprehensive education on sterile techniques is of paramount importance for patients undergoing PDC placement. Future research endeavors should focus on identifying appropriate patient population and insertion methods for PDC placement to reduce readmissions and complications.
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