Regional Anesthesia for Arteriovenous Fistula Surgery May Reduce Hospital Length of Stay and Reoperation Rates

Abstract

Background and Objectives: Regional anesthesia has been proposed as the preferred mode of anesthesia for arteriovenous fistula surgery due to its associated vasodilatory effects and fistula patency rates. We analyzed patient outcomes after arteriovenous fistula surgery for their association with the type of anesthesia received. Methods: The National Surgical Quality Improvement Project database was accessed to identify a cohort of 3199 patients undergoing arteriovenous fistula surgery from 2007 to 2015. Multiple regression models were used to examine the association of anesthesia with 12 postoperative outcomes. Additional multivariate logistic regression was performed to assess significant independent variables predictive of anesthesia choice. Results: Patients who received regional anesthesia had the shortest postoperative length of stay (0.67 [standard deviation: 2.0] days) compared to monitored anesthesia care/intravenous (IV) sedation (0.77 [1.8] days) and general anesthesia (1.44 [2.8] days). Administration of regional anesthesia was associated with a shorter length of stay compared to general anesthesia (odds ratio [OR]: 0.55, P = .001). Patients who received monitored anesthesia care/IV sedation had a lower risk of reoperation compared to general anesthesia (OR: 0.65, P = .012) but not compared to regional anesthesia (OR: 0.89, P = .759). Anesthesia type had no significant effects on other measured postoperative complications. Predictors of the type of anesthesia were age and surgical procedure as defined by Current Procedural Terminology code ( P < .001). Conclusions: Use of regional anesthesia is associated with a shorter postoperative length of stay after arteriovenous fistula surgery and lower risk of reoperation compared to general anesthesia or monitored anesthesia care/IV sedation. Regional anesthesia may be an excellent choice for arteriovenous fistula surgery to reduce postoperative length of stay and risk of reoperation.