Outpatient placement of subcutaneous venous access ports reduces the rate of infection and dehiscence compared with inpatient placement

摘要

Purpose: To determine whether the inpatient versus outpatient status of patients at the time of port placement affects the infection rate. Materials and Methods: Through a quality assurance database, all patients undergoing port insertion by interventional radiology personnel at a single institution between 2001 and 2010 were identified (N = 2,112). From this cohort, 1,030 patients with a known reason for port removal were retrospectively analyzed. All ports were of the same design. Data were analyzed according to inpatient/outpatient status at insertion and indications for port placement, including solid or hematologic malignancy and access for total parenteral nutrition or pheresis. Effects of inpatient/outpatient status on the reason for, and total time until, catheter removal were determined. Infections were defined as culture-positive bacteremia or clinically suspected port pocket infection. Results: No significant differences were seen in age (P =.32), sex (P =.4), or access site (P =.4) between groups. There was a significant difference in total infection-free catheter days between groups, with means of 241 days for inpatients and 305 for outpatients (P<.001). Inpatients had a significantly higher infection rate per 1,000 catheter-days versus outpatients (0.72 vs 0.5; P =.01). Similarly, there was a significant difference between inpatients and outpatients in time to port removal for infection or dehiscence, with the hazard of inpatients needing removal 45% greater than that of outpatients (P =.03). The increased hazard of inpatients needing port removal was significant even after accounting for placement indication (P =.02). Conclusions: Port placement in an outpatient setting results in longer infection-free survival for a wide variety of placement indications.