Hakan YABANOGLU, Sedat YILDIRIM, Tevfik AVCİ, Cağla BALİ, İlker Murat ARER

The effect of surgeon’s fatigue on early term patency and complications of arteriovenous fistulas: A prospective cohort study

Aim: Examining the effect of surgeon’s fatigue on early term patency and complications of arteriovenous fistula (AVF).Material and Methods: AVFs created for hemodialysis in patients with end-stage renal failure were included in the study. The patients were divided into 2 groups as those operated in the first operation of that day (Group 1) and those operated after the first or second operations (Group 2). The patients were compared with respect to clinical, demographics, postoperative, surgical variables, and operation duration.Results: A total of 100 patients underwent AVF operation. No statistically significant differences were found between the groups with respect to clinical, demographic, surgical, and postoperative variables. Efficiency of dialysis was found to be higher and complication rate lower in Group 1. But no statistical significance was obtained in terms of early dialysis efficiency and complication rates in between the groups (p>0.05). Complication rate was higher in Group 2 when compared according to operation time as 120, 120-240, and 240< minutes. But no statistical significance was obtained in this manner (p>0.05).Conclusions: Although not statistically significant, surgical fatigue factor and long operation time increase the rate of early complications and reduce early dialysis efficiency. We think that early term patency of AVF can also be affected by the complication rate. The effect of this variable can be statistically significant with studies having larger sample size.

PDF

___

Simoni G, Bonolami U, Civalleri D, et al. End-to-end arteriovenous fistula for chronic hemodialysis;11 years experience. Cardiovasc Surg 1994;2:63-6.
Nawaz S, Ali S, Shahzad I, et al. Arterio venous fistula experience at a tertiary care hospital in Pakistan. Pak J Med Sci 2013;29:161-5.
Kanko M, Sen C, Yavuz S, et al. Evaluation of arteriovenous fistulas made with the diamond-shaped anastomosis technique. Med Sci Monit 2012;18:MT67-70.
Çolak MC, Dişli O, Erdil N, et al. Turgut Özal Tıp Merkezi Kalp ve Damar Cerrahisi kliniğinde hemodializ için yapılan arteriovenöz fistüllerin erken ve geç dönem komplikasyonları. İnönü Üniversitesi Tıp Fakultesi Dergisi 2011;18:160-3.
Iyem H. Early follow-up results of arteriovenous fistulae created for hemodialysis. Vasc Health Risk Manag 2011;7:321-5.
Waakel JA, Huraib S, Mitwalli A, et al. Hemodialysis vascular access and complications. Vasc Surg 1994;28:107-13.
Keuter XH, De Smet AA, Kessels AG, et al.M, Welten RJ, Tordoir JH. A randomized multicenter study of the outcome of brachial-basilic arteriovenous fistula and prosthetic brachial-antecubital forearm loop as vascular access for hemodialysis. J Vasc Surg 2008;47(2):395-401.
Brimble KS, Rabbat CG, Schiff D, et al. The clinical utility of Doppler ultrasound prior to arteriovenous fistula creation. Semin Dial 2001;14:314-7.
Darçın OT, Kunt AS, Demir D, et al. Saphenofemoral loop fistula for hemodialysis access as an alternative route: A preliminary clinical study. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2005;146-8.
Tautenhahn J, Heinrich P, Meyer F. Arteriovenous fistulas for hemodialysis- patency rates and complications. a retrospective study. Zentralbl Chir 1994;119:506-10.
Beşirli K, Göde S. Vascular interventions for hemodialysis. Turkiye Klinikleri J Surg Med Sci 2006;2:75-80.
Meyer F, Müller JS, Bürger T, et al. Experiences with ambulatory arteriovenous shunt surgery. A cost-benefit analysis. Chirurg 2002;73:274-8.
Tedoriya T, Urayama H, Katada S, et al. A survey of vascular access for hemodialysis. Vasc Surg 1995;29:123-7.
Emrecan B, Saçar M, Önem G, et al. Ekstremiteyi tehdit eden arteriovenöz fistül. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2011;19:440-2.
Acıpayam M, Zor H, Yıldız GR, et al. Hemodiyaliz amaçlı acılan arteriyovenöz fistüllerin açıklığı üzerine etkili faktörler: Üç yıllık sonuçların değerlendirilmesi. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2013;21:59-62.
Sözudoğru AN, Cangel U, Eryüksel B, et al. Hemodializ amacıyla yapılan arteriovenoz fistüllerin kısa ve uzun dönem sonuçları: Retrospektif klinik çalışma. Türk Göğüs Kalp Damar Cerrahisi Dergisi 1999;7:135-9.
Gökşin İ, Baltalarlı A, Önem G, et al. Arteriovenöz fistül operasyonları: erken ve geç dönemde revizyon gerektiren komplikasyonlar. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2004;12:180-3.
So KSS. Access, Organ Donation adn Transplantation. In: Simmons R, Finch ME, Ascher NL, Najarian JS, Henriksen AJ, eds. Manual of Vascular Access, Organ Donation, and Transplantation. 1st edition. Springer: Veralg; 1984. p. 71-88.
Oto K. Vascular access. In: Cameron S, Danison AM, Grünfeld JP, Kerr D, Ritl E, eds. Oxford textbook of Clinical Nephrology. 2nd edition. Oxford: Oxford University Press; 1992. p. 1405-17.
Santoro D, Benedetto F, Mondello P, et al. Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis 2014;7:281-94.
Belli S, Yabanoglu H, Aydogan C, Surgical interventions for late complications of arteriovenous fistulas. Int Surg 2014;99:467-74.
Ahmed I, Pansota MS, Tariq M, et al. Arteriovenous Fistula: Surgical outcome and primary failure rate. JUMDC 2012;3:27-33.
Jenkins AM, Buist TA, Glover SD. Medium-term follow-up of forty autogenous vein and forty polytetrafluoroethylene (Gore-Tex) grafts for vascular access. Surgery 1980;88:667-72.
Sung RS, Galloway J, Tuttle-Newhall JE, et al. Organ donation and utilization in the United States, 1997-2006. Am J Transplant 2008;8:922-34.
US Renal Data System. 2010 Annual Data Report. http:// www.usrds.org/adr. accessed date 24/12/2011