Ramadan Omar I, Dember Laura M, Wang Grace J, Ng Jia Hwei, Mantell Mark P, Neuman Mark D
Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
BJA Open. 2022 Sep;3. doi: 10.1016/j.bjao.2022.100031. Epub 2022 Aug 22.
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.
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.
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 91/226 patients (40.3%) after general anaesthesia (=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; =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; =0.830). Similar findings were observed for overall maturation and composite endpoints accounting for potential survivorship bias.
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.
虽然全身麻醉常用于血液透析内瘘的创建，但有人认为区域或局部麻醉可带来更好的内瘘成熟结果。我们试图衡量麻醉类型与动静脉内瘘成熟之间的关联。
我们对血液透析内瘘成熟研究的数据进行了二次分析，该研究是一项多中心前瞻性队列研究，研究对象为2010年至2013年间接受单阶段上肢内瘘创建的晚期慢性肾病患者。我们使用多变量逻辑回归评估了麻醉类型与未辅助（无促进成熟干预措施）或总体（未辅助或辅助）内瘘成熟之间的关系。
在602名参与者中，336名（55.8%）接受了区域/局部麻醉，266名（44.2%）接受了全身麻醉。区域/局部麻醉后，164/309名患者（53.1%）实现了未辅助成熟，全身麻醉后为91/226名患者（40.3%）（P=0.003）。在对患者因素和内瘘类型进行调整后，区域/局部麻醉与未辅助成熟的几率高于全身麻醉相关（优势比1.72，95%置信区间1.24-2.39；P=0.001）。然而，在进一步调整临床中心固定效应后，未辅助成熟的几率在麻醉类型之间没有差异（优势比1.03，95%置信区间0.78-1.36；P=0.830）。对于总体成熟和考虑潜在生存偏差的复合终点，也观察到了类似的结果。
在调整患者因素和内瘘类型时，区域/局部麻醉与内瘘成熟几率增加相关。然而，在调整中心固定效应后，这种关联并未持续存在。需要进一步研究以更好地理解麻醉类型与中心因素之间的关系，从而优化内瘘手术后的结果。
