Fluoroscopic versus Laparoscopic Implantation of Peritoneal Dialysis Catheters: A Retrospective Cohort Study |
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Affiliation: | 1. Departments of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, P.O. Box 37968, Auckland 1151, New Zealand;2. Radiology, Middlemore Hospital, Counties Manukau District Health Board, P.O. Box 37968, Auckland 1151, New Zealand;3. Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;1. Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195;2. Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195;1. Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, GA 30322;2. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, GA 30322;1. DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL;2. Section of Interventional Nephrology, University of Miami Miller School of Medicine, Miami, FL |
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Abstract: | PurposeA previous clinical trial showed that radiologic insertion of first peritoneal dialysis (PD) catheters by modified Seldinger technique is noninferior to laparoscopic surgery in patients at low risk in a clinical trial setting. The present cohort study was performed to confirm clinical effectiveness of radiologic insertion in everyday practice, including insertion in patients with expanded eligibility criteria and by fellows in training.Materials and MethodsBetween 2004 and 2009, 286 PD catheters were inserted in 249 patients, 133 with fluoroscopic guidance in the radiology department and 153 by laparoscopic surgery. Survival analyses were performed with the primary outcome of complication-free catheter survival and secondary outcomes of overall catheter survival and patient survival. Outcomes were assessed at last follow-up, as long as 365 days after PD catheter insertion.ResultsIn the radiologic group, unadjusted 365-day complication-free catheter, overall catheter, and patient survival rates were 22.6%, 81.2%, and 82.7%, respectively, compared with 22.9% (P = .52), 76.5% (P = .4), and 92.8% (P = .01), respectively, in the laparoscopic group. Frequencies of individual complications were similar between groups. Adjusting for patient age, comorbidity, and previous PD catheter, the hazard ratio (HR) for catheter complications by radiologic versus laparoscopic insertion is 0.90 (95% confidence interval [CI], 0.62–1.31); the HR for overall catheter survival is 1.25 (95% CI, 0.59–2.65); and that for death is 2.47 (95% CI, 0.84–7.3).ConclusionsRadiologic PD catheter insertion is a clinically effective alternative to laparoscopic surgery, although there was poorer long-term survival with radiologic catheter placement, possibly because of preferential selection of radiologic insertion for more frail patients. |
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