title: Higher complication risk of totally implantable venous access port systems in patients with advanced cancer - a single institution retrospective analysis.
abstract: BACKGROUND
  Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer.
  
  
  OBJECTIVE
  The aim of this study was to assess the risk of port system failure in patients with advanced cancer.
  
  
  METHODS
  We conducted a retrospective cohort study in a comprehensive cancer centre.
  
  
  METHODS
  A detailed chart review was conducted among 566 patients with 573 ports inserted during January-June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion.
  
  
  RESULTS
  Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2-46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m(2) (HR = 3.4, P = 0.029) increased the risk of port system occlusion.
  
  
  CONCLUSIONS
  Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.
authors: Department of Haematology and Oncology, Mackay Memorial Hospital, Taipei, Taiwan. changyifang@gmail.com
authors: Yi-Fang
authors: YF
authors: Chang
authors: An-Chi
authors: AC
authors: Lo
authors: Chung-Hsin
authors: CH
authors: Tsai
authors: Pei-Yi
authors: PY
authors: Lee
authors: Shen
authors: S
authors: Sun
authors: Te-Hsin
authors: TH
authors: Chang
authors: Chien-Chuan
authors: CC
authors: Chen
authors: Yuan-Shin
authors: YS
authors: Chang
authors: Jen-Ruei
authors: JR
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors