# Surgical peritoneal dialysis catheter placement under local versus general anesthesia: impact on clinical safety, efficiency, and resource utilization

## TL;DR

This study compares the safety and efficiency of placing peritoneal dialysis catheters under general versus local anesthesia, finding that local anesthesia offers resource benefits without compromising safety.

## Contribution

The study provides evidence that local anesthesia for PD catheter placement is as safe as general anesthesia while improving perioperative efficiency.

## Key findings

- Local anesthesia was associated with shorter operating room and recovery times compared to general anesthesia.
- Perioperative complication rates were similar between the two anesthesia types after adjusting for patient risk factors.
- Local anesthesia improved workflow efficiency, especially in patients requiring isolation due to multidrug-resistant organisms.

## Abstract

Surgical peritoneal dialysis (PD) catheter implantation can be performed under various anesthetic strategies, evidence guiding the optimal approach regarding clinical safety and perioperative efficiency remains limited. This study evaluated perioperative outcomes and resource utilization in open surgical PD catheter implantation under general (GA) versus local/regional anesthesia (LA).

This retrospective single-center cohort study included all open surgical PD catheter implantations performed between 2010 and 2021. Clinical outcomes and perioperative workflow parameters were analyzed. Patients were stratified by anesthesia type (GA versus LA), comorbidities, and operating room (OR) isolation status related to multidrug-resistant organisms.

A total of 508 procedures were included (419 GA, 89 LA). Patients undergoing LA were older and more comorbid, with 49.4% classified as ASA ≥ 4 versus 14.6% in the GA group. Surgical procedures were comparable. LA was associated with shorter OR and post-anesthesia care unit times and faster transfer to definitive care units, indicating more efficient perioperative management. Postoperative surgical complication rates were comparable. Prolonged intensive care treatment occurred more frequently in LA patients, likely reflecting higher baseline illness severity. In patients with ASA ≥ 4, LA showed a trend toward reduced intraoperative catecholamine use (47.7% versus 67.2%; p = 0.0697). In multivariable analyses adjusting for age, ASA score, and cardiopulmonary comorbidities, anesthetic strategy was not independently associated with major safety outcomes. Among patients requiring isolation, GA resulted in disproportionate OR occupancy, whereas LA facilitated more efficient workflow regardless of isolation status.

LA is preferentially used in high-risk patients. After adjustment for baseline risk, its surgical safety is comparable to GA, while offering perioperative resource and organizational advantages. Tailoring anesthetic strategies to patient comorbidities and isolation requirements may improve perioperative workflow and resource utilization without compromising outcomes.