Evaluation of All-Cause Mortality Associated with Vascular Access Restoration Procedures: A Self-Controlled Case Series and Cohort Analysis Using USRDS Database
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Issue Date
2020-12
Authors
Paratane, Deepika '20
Degree
MS in Health Outcomes Research
Advisor
Doll, Margaret
Committee Members
McLaughlin, Colleen
Swain, Carol-Ann
Cardone, Katie
Swain, Carol-Ann
Cardone, Katie
Journal Title
Journal ISSN
Volume Title
Abstract
Objectives: The goal of this thesis was to evaluate the association between vascular access restoration procedures for thrombosis and mortality among end-stage renal disease (ESRD) patients. The specific aims are to: (i) estimate the risk of all-cause mortality, and (ii) identify risk factors associated with mortality, within 7 days of a vascular access restoration procedure.
Methods: Data are from the United States Renal Data System (USRDS) and encompass 2011-2015. A self-controlled case series design with conditional Poisson regression was implemented in aim (i) to compare 7-day mortality risk with a control period of 8 to 90 days following the procedure. In aim (ii), a cohort study with logistic regressions adjusted for patient age and comorbidities were performed to examine the relationship between patient and procedural characteristics and 7-day mortality. In both objectives, models were stratified by procedure setting (i.e., inpatient vs. outpatient) to examine potential effect measure modification.
Results: In aim (i), 516 patients were included in the study population. The risk of 7-day mortality was 1.4 (95% confidence interval (CI): 1.1, 1.9) times higher in comparison with the control period. In stratified analyses, inpatients experienced 2.8 (95% CI: 1.8, 4.4) times greater 7-day mortality than the control period, however, no differences in mortality was found among outpatients (RR: 1.0, 95% CI: 0.7, 1.5). In aim (ii), 10,821 patients were included in the study cohort. In adjusted analyses, outpatients undergoing a catheterization or combined procedure had a 3.9 (95% CI: 1.2, 13.3) and 2.9 (95% CI: 1.4, 5.9) times greater 7-day mortality risk than participants undergoing an endovascular procedure, respectively, and a 5.2 (95% CI: 1.5, 17.8) times greater risk of mortality if the procedure was performed by a provider with a specialty other than ESRD/vascular access procedures. Among inpatients, each additional day since the last date of dialysis and the procedure was associated with a 1.1 (95% CI: 1.0, 1.3) times greater mortality risk.
Conclusions: Our study suggests there exists an increased risk of 7-day mortality following a vascular access restoration procedure among inpatients, and that several patient and procedure-related characteristics were associated with a higher risk of death.
Citation
Paratane D. "Evaluation of All-Cause Mortality Associated with Vascular Access Restoration Procedures: A Self-Controlled Case Series and Cohort Analysis Using USRDS Database." Albany College of Pharmacy and Health Sciences, New York, Proquest/UMI, 2020.
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