Association of surgeon volume and operative factors with early thrombosis of arteriovenous fistulas for hemodialysis.

Abstract

Although arteriovenous fistula (AVF) is the ideal initial option for hemodialysis access, failure can occur due to early thrombosis or lack of maturation. Surgeon volume has previously been associated with higher rates of maturation, but the relationship between volume and early thrombosis remains unknown. All adults undergoing cephalic-based AVF between 2014 and 2019 were identified from five safety net hospitals within the Los Angeles County Department of Health Services system. Surgeons were divided into two groups based on whether their 30-day thrombosis rate was below (Group A) or above (Group B) the mean. The relationship between selected operative characteristics and surgeon volume on surgeon early thrombosis rates was analyzed. Sixteen surgeons performed 828 cephalic-based AVFs. Group A surgeons had lower rates of early thrombosis overall, 3.8% vs 15.4% (P < .001). There were no differences in age, sex, or comorbidities among the patients operated on by Group A and Group B surgeons. Following adjustment, Group A surgeons were more likely to use intraoperative systemic anticoagulation (odds ratio [OR], 8.745; 95% confidence interval [CI], 5.875-13.019; P < .001), have an AVF volume >40 (OR, 2.847; 95% CI, 1.853-4.374; P < .001), and have an operating time >1.5 hours (OR, 2.031; 95% CI, 1.387-2.974; P < .001). However, Group A surgeons had lower odds of utilizing intraoperative antibiotics (OR, 0.261; 95% CI, 0.130-0.544) and general anesthesia (OR, 0.340; 95% CI, 0.175-0.658; P < .001). The present analysis identified variability in 30-day AVF thrombosis. Surgeons with low rates of early thrombosis were likely to have a higher case volume, use intraoperative anticoagulation, and have longer operative times.