Investigation of Complications Following Port Insertion in a Cancer Patient Population: A Retrospective Analysis

Abstract

Central venous access devices, specifically implantable ports, play an essential role in the care of oncology patients; however, complications are prevalent. This retrospective single-institutional review was performed to identify rates of complications from port placement and potential factors associated with these events. A retrospective analysis of 539 cancer patients who underwent port insertion between March 2016 and March 2017 at our institution was conducted. Data examining 18 potentially predictive factors were collected, and multivariate analysis was conducted using logistic regression and odds ratios (ORs) with standard errors to determine predictive factors. Out of 539 patients, 100 patients (19%) experienced 1 complication, and 12 patients (2%) experienced 2 or more complications. An overall lower rate of complications was seen in patients on therapeutic anticoagulation (OR: 0.17, P < .001) or on antiplatelet agents (OR: 0.47, P = .02). No patients on therapeutic anticoagulation developed venous thromboembolism (VTE; 0%). Right-sided port insertion was associated with decreased rates of infection (OR: 0.44, P = .04). Insertion as inpatient was associated with an increased risk for mechanical failure (OR: 4.60, P < .01). This analysis identified multiple predictive factors that can potentially put patients at a higher risk of experiencing complications following port insertion. Our data show lower rates of VTE for patients on anticoagulation or antiplatelet therapy. Further analysis is also necessary to determine why port insertion as an inpatient places patients at a higher risk of complications. This study highlights the risks associated with port placement and prompts the clinician to have an informed discussion with the patient weighing the risks and benefits.

Alternate Cervical Venous Access Sites for Implantable Port Catheters: Experience at a Single Quaternary Care Institution

“…Notably, most of these infectious complications occurred greater than 30 days following the port insertion, suggesting a complication of port access or infusion technique as an inciting factor as opposed to the port insertion technique. The data in the current study compare favorably to the published literature with respect to complication rates which have been reported between 7.2 and 19.0% [13][14][15]. Similar to our findings, port infections and sepsis also accounted for the majority of the port-related complications reported in these publications, occurring in 2.5-6.9% of the studied cohorts.…”

“…The size of the control group was determined to test if the complication rate among alternate access patients was non-inferior to the control group. Using a two-sample proportion test and assuming a complication rate of 10% [13][14][15], 24 patients in the alternate venous access group and 72 control patients provide 88% power at a significance level of 5% to reject the null hypothesis that alternate access is inferior to traditional access for a non-inferiority margin of 20%. The non-inferiority margin of 20% was selected based upon the sample size of the alternate access group and statistical power.…”

Small molecule drugs for atopic dermatitis, rheumatoid arthritis, and hereditary angioedema

“…Oral medications may reduce the treatment burden for patients compared with subcutaneous or intravenous therapies by eliminating injection-related AEs, venous access issues (which are particularly prevalent in pediatric, geriatric, and obese patients), and difficulties associated with indwelling ports. [50][51][52][53] Furthermore, oral medications are a viable treatment option for patients with a needle phobia. 54,55 Oral treatments may also be associated with increased convenience and ease of administration; reduced treatment-related stress and anxiety; and reduced impact on work and everyday activities, which would all contribute to improved QoL for patients.…”