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.

Exparel/Peripheral Catheter Use in the Ambulatory Setting and Use of Peripheral Catheters Postoperatively in the Home Setting.

PURPOSE OF REVIEW: With the increasing number of ambulatory surgeries being performed, regional anesthesia has become an increasingly popular anesthetic modality, and many choices exist to provide efficient, effective quality perioperative analgesia. In this paper, we will review the various regional anesthesia options in addition to the advantages and disadvantages of each. Lastly, we will discuss liposomal bupivicaine, a long acting local anesthetic, and its future role in the anesthesiologist's armamentarium. The aim of the publication is to provide a general overview of regional anesthesia as well as to discuss the advantages and disadvantages of this modality. Additionally, we sought to review the basics of liposomal bupivicaine as well as the relevant literature. RECENT FINDINGS: The results regarding liposomal bupivicaine are mixed and mainly focuses on local infiltration and intra-articular injections. There are no known studies specifically comparing liposomal bupivicaine to bupivicaine hydrochloride in ultrasound-guided nerve blocks. There is some encouraging data regarding liposomal bupivicaine, but further studies are needed before it is adopted as a mainstay of treatment. In addition to efficacy, additional investigations are needed to evaluate cost as this could be a major impediment to its implementation.