Perioperative Outcomes in Vascular Surgical Access for Hemodialysis- Our Experience

Background: We present data from 210 chronic kidney disease (CKD) patients who underwent arteriovenous fistula (AVF) creation as a subset analysis of a larger study that analyzed the perioperative outcomes of 770 CKD patients posted for noncardiac surgeries. Native fistulae are best known for their longevity and choice of hemodialysis access. Objectives: We aim to present our experience, including preoperative patient profile, incidence, and description of perioperative complications and death. Methods: The subset of patients undergoing AVF creation procedures was extracted from a larger multicenter dataset of 770 CKD patients undergoing noncardiac surgeries. Predictors of cardiac risk were identified for all patients, including the Revised Cardiac Risk Index (RCRI) and Clavien–Dindo scoring for surgical complications. Mortality and readmissions within 30 days were recorded. Results: Out of 210 patients, radiocephalic fistulae were created in 97 (46.19%) patients, brachial fistulae in 105 (50%) patients, and arteriovenous grafts and pseudoaneurysm exploration in 8 (3.8%) patients. The mean age was 54.67 years with 66.1% of males. All our patients were American Society of Anesthesiologists III and above. The RCRI score was more than 3 in 68 patients, of which 40 patients developed complications. Clavien–Dindo complications were significantly associated with RCRI ( P = 0.02), type of surgery ( P = 0.025), metabolic equivalents ( P = 0.007), and diabetes mellitus ( P = 0.005). Preemptive AVF was created in 73 (34.7%) patients, and 137 (65.2%) patients were on dialysis at the time of surgery. Mortality within 30 days was recorded in 7 patients and readmission in 50 patients (23.8%). Conclusion: In patients with preoperative higher RCRI grading, type of vascular access should be meticulously chosen.