Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement

Abstract

BackgroundTotally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate.Materials and methodsData on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room.ResultsBetween 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30–120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic.ConclusionOur results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

Experience in totally implantable venous port catheter: Analysis of 3,000 patients in 12 years

“…Furthermore, Feo et al [17] investigated the costefficiency of chest port placements when performed in the operation room or the outpatient clinic. They reported that the average cost for chest port placement was significantly higher when performed in the operation room compared to the outpatient clinic.…”

Complications and management strategies of totally implantable venous access port insertion through percutaneous subclavian vein

“…[1][2][3] Previous studies regarding the TIVAD insertion are summarized in Table 4. According to the existing Guth [5] Yildizeli et al [6] Araújo et al [7] Narducci et al [8] Keum et al [9] Seok et al [10] Nagasawa et al [11] Aziret et al [12] An et al [13] Gurkan et al [14] Ma et al [15] Zerati et al [16] Feo et al [17] Bazine et al [18] Yanık et al [19] 2018 3000 SV, IJV Kim et al [20] literature, the overall complication rate following TIVAD insertion ranges from 3.1 to 33.9%. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The overall complication rate in our study population was 12.5%, consistent with the results reported in previous studies.…”

An unusual catheter malposition following totally implantable venous access port insertion: The catheter tip located into the right axillary vein

“…According to the large case series, the rate of catheter mispositioning following TIVAP insertion varies between 0.2% and 3.1% [2,[7][8][9][10][11][12][13][14][15][16][17] (Table 1). [16] 2018 3000 0.2% 9.6% Kim et al [17] 2019 843 0.3% 4%…”

“…It has been indicated that TIVAP insertion under imaging guidance reduces the procedure-related complication rates [18][19][20]. On the other hand, surgeons use either cut-down or percutaneous landmark-based technique for implantation, with low complication rates [2,[7][8][9][10][11][12][13][14][15][16][17]. Since we, the surgeons, are very familiar with blind-landmark technique as well as vascular anatomy of neck and chest regions, and also may recognize and treat the potential procedure-related complications quickly and properly, we applied the blindlandmark technique during TIVAP insertion but unfortunately observed this adverse event.…”