Association between anaesthesia type and arteriovenous fistula maturation

Omar I Ramadan; Laura M Dember; Grace J Wang; Jia Hwei Ng; Mark P Mantell; Mark D Neuman

doi:10.1016/j.bjao.2022.100031

Association between anaesthesia type and arteriovenous fistula maturation

BJA Open. 2022 Sep:3:100031. doi: 10.1016/j.bjao.2022.100031. Epub 2022 Aug 22.

Authors

Omar I Ramadan^{1

2}, Laura M Dember^{3

4

5}, Grace J Wang^{1

2}, Jia Hwei Ng⁶, Mark P Mantell¹, Mark D Neuman^{2

7}

Affiliations

¹ Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
² Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
³ Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁴ Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁵ Department of Biostatistics and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁶ Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA.
⁷ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Abstract

Background: Whereas general anaesthesia is commonly used for haemodialysis fistula creation, regional or local anaesthesia has been posited to lead to better fistula maturation outcomes. We sought to measure the association between anaesthesia type and arteriovenous fistula maturation.

Methods: We performed a secondary analysis of data from the Hemodialysis Fistula Maturation study, a multicentre prospective cohort study of advanced chronic kidney disease patients who underwent single-stage upper extremity fistula creation between 2010 and 2013. We evaluated the relationship between anaesthesia type and unassisted (without maturation-facilitating interventions) or overall (unassisted or assisted) fistula maturation using multivariable logistic regression.

Results: Among 602 participants, 336 (55.8%) received regional/local anaesthesia and 266 (44.2%) received general anaesthesia. Unassisted maturation occurred in 164/309 patients (53.1%) after regional/local vs 91/226 patients (40.3%) after general anaesthesia (P=0.003). After adjustment for patient factors and fistula type, regional/local anaesthesia was associated with greater odds of unassisted maturation than general anaesthesia (odds ratio 1.72, 95% confidence interval 1.24-2.39; P=0.001). However, after further adjustment for clinical centre fixed effects, odds of unassisted maturation did not differ by anaesthesia type (odds ratio 1.03, 95% confidence interval 0.78-1.36; P=0.830). Similar findings were observed for overall maturation and composite endpoints accounting for potential survivorship bias.

Conclusions: Regional/local anaesthesia was associated with increased odds of fistula maturation when adjusting for patient factors and fistula type. However, this association did not persist after adjusting for centre fixed effects. Future research is needed to better understand the relationship between anaesthesia type and centre factors to optimise outcomes after fistula surgery.

Keywords: anaesthesia type; arteriovenous fistula maturation; end-stage renal disease; general anaesthesia; haemodialysis; local anaesthesia; regional anaesthesia.

Abstract

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