30-day mortality after haemodialysis vascular access surgery: A retrospective observational study

Thomas Jorna*, Shona Methven, Rommel Ravanan, Andrew R. Weale, Ronelle Mouton

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

2 Citations (Scopus)

Abstract

Purpose: The prevalence of haemodialysis is increasing globally. There is a consensus of international opinion that permanent vascular access is preferred for haemodialysis. Patients with end-stage renal disease carry a high burden of cardiovascular comorbidity. There is a lack of data to quantify the post-operative risk of vascular access surgery. This study looked to establish the 30-day post-operative mortality for patients undergoing surgery to create vascular access and to measure for differences between the types of access created and the mode of anaesthesia. Methods: We conducted a retrospective study of all cases over a 5-year period at a tertiary renal unit in the UK. Data recorded included co-morbidity, time on renal replacement therapy, type of access created, mode of anaesthesia and 30-day mortality. The incident risk was calculated and logistic regression used to calculate the adjusted odds ratio. Results: A total of 1404 operations were included. 30-day mortality for the whole cohort was 1.1% (16/1404). The adjusted odds ratio of death at 30 days using an upper limb fistula as a reference was 5.27 for an upper limb graft (p = 0.005) and 11.51 (p = 0.007) for any lower limb access. Using local anaesthesia as a reference the adjusted odds ratio for surgery under general anaesthesia was 6.28 (p = 0.001). Conclusions: Vascular surgery for haemodialysis is associated with significant and variable post-operative mortality; this study highlights the need for careful pre-operative planning in this complex group of patients.

Original languageEnglish
Pages (from-to)215-219
Number of pages5
JournalJournal of Vascular Access
Volume17
Issue number3
DOIs
Publication statusPublished - 5 Apr 2016

Keywords

  • Arteriovenous fistulae
  • Chronic renal failure
  • Haemodialysis
  • Mortality
  • Vascular access surgery

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