title: Objective and subjective assessment of physician labor and resource utilization in maintenance percutaneous transluminal angioplasty of nonthrombosed hemodialysis arteriovenous fistulas versus arteriovenous grafts.
abstract: OBJECTIVE
  To complement prior studies that have shown that arteriovenous fistula (AVF) thrombectomies require more time and equipment than arteriovenous graft (AVG) thrombectomies by measuring work via established instruments to determine whether there is also a difference in maintenance percutaneous transluminal angioplasty (PTA) of nonthrombosed AVFs versus AVGs.
  
  
  METHODS
  PTA procedures performed on a consecutive cohort of 42 patients with AVFs and 27 patients with AVGs were prospectively compared. To quantify resource utilization, procedure time and disposable equipment were measured. Established instruments developed by the American Medical Association for Current Procedural Terminology code valuation were used to measure subjective "physician work," including mental effort and judgment, technical skill, physical effort, and psychological stress. These items were scored by 1 of 12 attending interventional radiology physicians performing the procedure.
  
  
  RESULTS
  Mean PTA procedure time was 74 minutes (range, 18-183 minutes) for AVFs and 71 minutes (range, 28-204 minutes) for AVGs; hemostasis time was 12 minutes for AVFs and 11 minutes for AVGs. There was no significant difference in equipment use between groups. "Physician work" for AVFs scored significantly higher in four categories (P≤ .05).
  
  
  CONCLUSIONS
  Using established subjective instruments, maintenance PTA of AVFs was scored as more cognitively, physically, and psychologically demanding than maintenance PTA of AVGs. However, there was no significant difference in resource utilization between maintenance PTA of AVFs versus AVGs, as has been previously shown with thrombectomy of thrombosed AVFs and AVGs.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Coryell
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Maxim
authors.initials: M
authors.lastname: Itkin
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Chittams
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D017130:Angioplasty / Q000706:statistics & numerical data*; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D061646:Operative Time; D015143:Philadelphia / Q000453:epidemiology; D010820:Physicians / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D013927:Thrombosis / Q000453:epidemiology / Q000601:surgery; D016526:Workload / Q000706:statistics & numerical data*