title: Closed cannulation of subclavian vein vs open cut-down of cephalic vein for totally implantable venous access port (TIVAP) implantation: protocol for a systematic review and proportional meta-analysis of perioperative and postoperative complications.
abstract: BACKGROUND
  Totally implantable venous access port (TIVAP) implantation is one of the most often performed operations in general surgery (over 100,000/year in Germany). The two main approaches for TIVAP placement are insertion into the cephalic vein through an open cut-down technique (OCD) or closed cannulation technique of the subclavian vein (CC) with Seldinger technique. Both procedures are performed with high success rates and very low complication frequencies. Because of the low incidence of complications, no single interventional trial is able to report a valid comparison of peri- and postoperative complication frequencies between both techniques. Therefore, the aim of this systematic review is to summarize evidence for peri- and postoperative complication rates in patients undergoing OCD or CC.
  
  
  METHODS
  A systematic literature search will be conducted in The Cochrane Library, MEDLINE, and Embase to identify randomized controlled trials (RCTs), observational clinical studies (OCS), or case series (CS) reporting peri- and/or postoperative complications of at least one implantation technique. A priori defined data will be extracted from included studies, and methodological quality will be assessed. Event rates with their 95% confidence intervals will be derived taking into account the follow-up time per study by patient-months where appropriate. Pooled estimates of event rates with corresponding 95% confidence intervals will be calculated on the base of the Freeman-Tukey double arcsine transformation within a random effect model framework.
  
  
  CONCLUSIONS
  The findings of this systematic review with proportional meta-analysis will help to identify the procedure with the best benefit/risk ratio for TIVAP implantation. This may have influence on daily practice, and data may be implemented in treatment guidelines. Considering the impact of TIVAP implantation on patients' well being together with its socioeconomic relevance, patients will benefit from evidence-based treatment and health-care costs may also be reduced.
  
  
  BACKGROUND
  PROSPERO CRD42013005180.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Ulla.Klaiber@med.uni-heidelberg.de.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Ulla.Klaiber@med.uni-heidelberg.de.
authors.forename: Ulla
authors.initials: U
authors.lastname: Klaiber
authors.affiliation: Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Kathrin.Grummich@med.uni-heidelberg.de.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Grummich
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany. Jensen@imbi.uni-heidelberg.de.
authors.forename: Katrin
authors.initials: K
authors.lastname: Jensen
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany. Saure@imbi.uni-heidelberg.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Saure
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Pietro.Contin@med.uni-heidelberg.de.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Pietro.Contin@med.uni-heidelberg.de.
authors.forename: Pietro
authors.initials: P
authors.lastname: Contin
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Felix.Huettner@med.uni-heidelberg.de.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Felix.Huettner@med.uni-heidelberg.de.
authors.forename: Felix J
authors.initials: FJ
authors.lastname: Hüttner
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Markus.Diener@med.uni-heidelberg.de.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Markus.Diener@med.uni-heidelberg.de.
authors.forename: Markus K
authors.initials: MK
authors.lastname: Diener
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Phillip.Knebel@med.uni-heidelberg.de.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Phillip.Knebel@med.uni-heidelberg.de.
authors.forename: Phillip
authors.initials: P
authors.lastname: Knebel
mesh_terms: D002404:Catheterization / Q000009:adverse effects*; D006801:Humans; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D012107:Research Design; D013350:Subclavian Vein; D000078202:Systematic Reviews as Topic; D062666:Vascular Access Devices; D016748:Venous Cutdown / Q000009:adverse effects*; D015201:Meta-Analysis as Topic