Evaluation of the safety of arteriovenous fistula creation surgery in ambulatory versus inpatient hospital setting

Arteriovenous fistula (AVF) creation surgeries necessary for dialysis in patients with end-stage renal disease have traditionally been performed in inpatient settings under general anesthesia. Although more recent studies have demonstrated that these surgeries can be safely performed in outpatient centers with low postoperative complication rates, a direct comparison to surgeries performed in inpatient settings has not been investigated. This study sought to directly compare the rate of complications and postoperative mortality in AVF creation surgeries performed in outpatient and inpatient surgical centers. This multicenter retrospective study recorded emergency department (ED) visits, inpatient admissions, and mortality following 179 outpatient and 146 inpatient AVF surgeries in 2015 and 2016. Rates of mortality at 30 days and ED visits and inpatient admissions at 24-h and seven-day time points were compared in inpatient and outpatient groups. Following outpatient and inpatient surgeries, the rates of inpatient admissions in seven days were 0.685% and 4.47%, respectively, and the rates of ED visits in seven days were 1.37% and 3.91%. There were no mortalities in either group in 30 days. There was no difference between groups in the rate of ED visits within seven days or hospital visits within 24 h. There was a significantly lower rate of admissions (P = 0.0386) and total hospital visits (P = 0.0131) within seven days for outpatient surgeries. This study provides a direct comparison of postoperative complications in inpatient and outpatient AVF surgeries, further suggesting that providers can safely perform AVF surgeries in ambulatory centers.