Brachiocephalic arteriovenous fistulas (BCF) are commonly placed in outpatient settings. The impact of general (GA), regional (RA), or local (LA) anesthesia on perioperative recovery and fistula maturation/patency after outpatient BCF creations is unknown. We evaluated whether outcomes of outpatient BCF creations vary based on anesthesia modality.
The Vascular Quality Initiative (2011-2018) national database was queried for outpatient BCF creations. Anesthesia modalities included GA, RA, and LA. Perioperative, three-month, and one-year outcomes were compared between GA versus RA/LA anesthesia types.
Among 3,527 outpatient BCF creations, anesthesia types were GA in 1,043 (29.6%), RA in 1,150 (32.6%), and LA in 1,334 (37.8%). Patients receiving GA were more often younger, obese, Medicaid recipients, without coronary artery disease, and treated in non-office-based settings (P<.05 for all). GA compared with RA/LA cohorts were more often admitted postoperatively (5.3% vs 2.4%, P<.001), but had similar rates of thirty-day mortality (.9 vs .6%, P=.39). Three-month access utilization for hemodialysis was lower in GA than in RA/LA cohorts (12.6% vs 23.6%, P<.001). Kaplan-Meier analysis showed that GA and RA/LA cohorts had similar one-year primary access occlusion-free survival (43.6% vs 47.1%, P=.24) and endovascular/open reintervention-free survival (57.2% vs 57.6%, P=.98). On multivariable analysis, GA compared with RA/LA use was independently associated with increased postoperative admission (OR 1.7, 95% CI 1.08-2.67, P=.02) and decreased three-month access utilization (OR .39, 95% CI .25-.61, P<.001), but had similar one-year access occlusion (HR 1.09, 95% .9-1.32, P=.36) and reintervention (HR 1.02, 95% CI .82-1.26, P=.88). On subgroup analysis of the RA/LA cohort, RA compared with LA was associated with increased three-month access utilization (OR 1.6, 95% CI 1.01-2.5; P=.04) and one-year access reintervention (HR 1.46, 95% CI 1.12-1.89), but had similar one-year access occlusion (HR 1.2, 95% CI .95-1.51, P=.13).
Compared with regional/local anesthesia use, general anesthesia use in patients undergoing outpatient BCF creations was associated with increased hospital admissions, decreased access utilization at three months, and similar one-year access occlusion and reintervention. Regional/local anesthesia is preferable to expedite recovery and access utilization.
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