title: [A totally implantable venous access device. Implantation in general or local anaesthesia? A retrospective cost analysis].
abstract: BACKGROUND
  Implantation of venous access port systems can be performed in local or general anesthesia. In spite of the increasing rate of interventionally implanted systems, the surgical cut-down represents a safe alternative. Thus, the question arises whether--in context to the increasing health-economic pressure--open implantation in general anesthesia is still a feasible alternative to implantation in local anesthesia regarding OR efficiency and costs.
  
  
  METHODS
  In a retrospective analysis, 993 patients receiving a totally implantable venous access device between 2001 and 2007 were evaluated regarding OR utilization, turnover times, intraoperative data and costs. Implantations in local (LA) and general anesthesia (GA) were compared.
  
  
  RESULTS
  GA was performed in 762 cases (76.6 %), LA was performed in 231 patients (23.3 %). Mean operation time was similar in both groups (LA 47.27 +/- 1.40 min vs. GA 45.41 +/- 0.75 min, p = 0.244). Patients receiving local anesthesia had a significantly shorter stay in the OR unit (LA 95.9 +/- 1.78 min vs. GA 105.92 +/- 0.92 min; p < 0.001). Specifically, the time from arrival in the operating room to surgical cut (LA 39.57 +/- 0.69 min vs. GA 50.46 +/- 0.52 min; p < 0.001) was shorter in the LA group. Personnel and material costs were significantly lower in the LA group compared with the GA group (LA: 400.72 +/- 8.25 euro vs. GA: 482.86 +/- 6.23 euro; p < 0.001) Blood loss as well as duration and dose of radiation were similar in both groups.
  
  
  CONCLUSIONS
  Our study shows that implantation of totally implantable venous access port systems in local anesthesia is superior in comparison to the implantation under general anesthesia regarding procedural times in the OR unit and costs. With the same operation duration, but less personnel and material expenditure, implantation in local anesthesia offers a potential economic advantage by permitting faster changing times. Implantation in GA only should be performed at a special request by the patient or in difficult venous conditions.
authors.affiliation: Klinik für Allgemeine Chirurgie, Viszeral-, Gefäss- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar.
authors.forename: J
authors.initials: J
authors.lastname: Schuld
authors.forename: S
authors.initials: S
authors.lastname: Richter
authors.forename: M R
authors.initials: MR
authors.lastname: Moussavian
authors.forename: O
authors.initials: O
authors.lastname: Kollmar
authors.forename: M K
authors.initials: MK
authors.lastname: Schilling
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000191:economics*; D000772:Anesthesia, Local / Q000191:economics*; D002408:Catheters, Indwelling / Q000191:economics*; D017046:Cost Savings / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies