Massachusetts General Hospital Wellesley, Massachusetts
Objectives: Peritoneal dialysis (PD) provides patients with a convenient, home-based method for dialysis at a reduced expense compared to in-center hemodialysis. PD catheters are most commonly placed laparoscopically in a hospital outpatient setting, but can also be inserted percutaneously. The International Society for Peritoneal Dialysis (ISPD) targets an estimated peritonitis rate of 0.40 episodes per year at risk. We hypothesize that PD catheters can be safely inserted in an office-based laboratory (OBL), outperform published quality metrics, and decrease overall costs.
Methods: All PD catheter placements within five OBLs were reviewed between February 2022 and March 2025. Patient and procedural demographics included age, sex, BMI, presence of end-stage kidney disease, various cardiac comorbidities, smoking history, prior abdominal surgery, and antiplatelet/anticoagulant medication use. Procedural information included technical success, procedure time, fluoroscopy time, contrast dose, procedural hematomas, total catheter days, and subsequent peritonitis. Chi-Square test was used to calculate the observed and expected peritonitis rates. The published Medicare Hospital outpatient laparoscopic reimbursement of $6,175.29, and the office reimbursement of $913.79 were used to estimate savings to the health care system.
Results: 65 patients underwent PD catheter insertion in the office setting. The mean age was 62.2. 63.1% were male, and the mean BMI was 27.4. 61.5% of patients were on dialysis at the time of catheter insertion. 41.5% of patients were on antiplatelet or anticoagulant medications, with a mean of 0.41 prior abdominal surgeries per patient. Procedural technical success was 98.5%, with a mean procedure time was 57.8 minutes. Mean fluoroscopy time was 2.5 minutes, and mean contrast dose was 5.5 mL. Three procedures (4.6%) resulted in a hematoma, not requiring intervention. Subsequent catheter infection developed in 10.8% of cases between 23-525 days post implantation. There were 7 episodes of peritonitis over 80.39 catheter-years, a rate of 0.09 episodes per patient-year below the accepted rate of 0.40 episodes per patient-year (p <.00001).
Conclusions: Percutaneous PD catheter insertion can be safely performed in an office-based setting with high rates of technical success, low procedural expense rates, and low rates of catheter infection outperforming published quality guidelines. Reduced costs for catheter insertion in the ambulatory setting represent significant cost savings to the health care system, unburdening crowded operating rooms, and should become the standard site of care.
