title: Outpatient placement of subcutaneous venous access ports reduces the rate of infection and dehiscence compared with inpatient placement.
abstract: OBJECTIVE
  To determine whether the inpatient versus outpatient status of patients at the time of port placement affects the infection rate.
  
  
  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.
authors.affiliation: Department of Radiology and Division of Interventional Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
authors.forename: Nirnimesh
authors.initials: N
authors.lastname: Pandey
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Chittams
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002405:Catheterization, Central Venous / Q000401:mortality*; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult