title: 30-day mortality after haemodialysis vascular access surgery: a retrospective observational study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Renal Medicine, Hull Royal Infirmary, Hull - UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jorna
authors.affiliation: School of Clinical Sciences, University of Bristol, Renal Unit, Southmead Hospital, Bristol - UK.
authors.forename: Shona
authors.initials: S
authors.lastname: Methven
authors.affiliation: Renal Unit, Southmead Hospital, Bristol - UK.
authors.forename: Rommel
authors.initials: R
authors.lastname: Ravanan
authors.affiliation: Department of Transplant and Vascular Surgery, Southmead Hospital, Bristol - UK.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Weale
authors.affiliation: Department of Anaesthesia, Southmead Hospital, Bristol - UK.
authors.forename: Ronelle
authors.initials: R
authors.lastname: Mouton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000401:mortality*; D015897:Comorbidity; D016208:Databases, Factual; D004739:England; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D055815:Young Adult