TOTALLY IMPLANTABLE CENTRAL VENOUS ACCESS PORTS FOR LONG-TERM CHEMOTHERAPY - A PROSPECTIVE-STUDY ANALYZING COMPLICATIONS AND COSTS OF 333 DEVICES WITH A MINIMUM FOLLOW-UP OF 180 DAYS

Background: A few data are available from analyses of the complication s and costs of central venous access ports for chemotherapy. This pros pective study deals with the complications and global costs of central venous ports connected to a Groshong catheter for deliverance of long -term chemotherapy. Patients and methods: Patients with a variety of s olid neoplastic diseases requiring chemotherapy who were undergoing pl acement of implantable ports over a 30-month period (1 October 1994 to 31 March 1997) have been prospectively studied. Follow-up continued u ntil the device was removed or the study was closed (30 September 1997 ); patients with uneventful implant experience and subsequent follow-u ps of less than 180 days were not considered for this study. A single port, constructed of titanium and silicone rubber (Dome Porto, Bard In c., Salt Lake City, USA), was used, connected to an 8 F silastic Grosh ong(TM) catheter tubing (Bard Inc., Salt Lake City, USA). Two-hundred ninety-six devices were placed in the operating room under ftuoroscopi c control even in the patients treated and monitored in a day-hospital setting; 37 of them were in an angiographic suite. A central venous a ccess form was filled in by the operator after the procedure and all p orts were followed prospectively for device-related and overall compli cations. The average purchase cost of the device was obtained from the hospital charges, based on the costs applied during the 30-month peri od of the study. Insertion and maintenance costs were estimated by obt aining the charges for an average TIAP implant and its subsequent use; the costs of complication management were assessed analytically. The total cost of each device was defined as the purchase cost plus the in sertion cost plus the maintenance cost plus the cost of treatment of t he complications, if any. The cost of removing the TIAP was also inclu ded in the economic analysis when required by the treatment of the com plication. Results: Three hundred thirty-three devices, for a total of 79,178 days in situ, were placed in 328 patients. Five patients recei ved second devices after removal of the first. In all cases the follow -up was appropriate (median 237 days, range 180-732). Early complicati ons included 10 pneumothoraxes (3.4%; six tube-thoracostomies were app lied, 1.8%) and six revisions for port and/or catheter malfunction (ov erall early complications = 16, 4.48%). Late complications comprised f ive instances of catheter rupture and embolization (1.5%, 0.063 episod es/1000 days of use), five of venous thrombosis (1.5%, 0.063 episodes/ 1000 days of use), one of pocket infection (0.3%, 0.012 episodes/1000 days of use), and eight of port-related bacteremia (2.4%, 0.101 episod es/1000 days of use). The infections were caused by coagulase-negative Staphylococcus aureus (five cases), Bacillus subtilis (one case), Str eptococcus lactaceae (one case) and an unknown agent (one case); port removal was necessary in six of eight cases. The total cost per patien t treated for a six-month period, consisting of the costs of purchase and implantation, treatment of early and late complications, and of ma intenance of the device, is US$1,970. Conclusions: This study represen ts the largest published series of patients with totally implantable a ccess ports connected to a Groshong catheter. We have shown that US$2, 000 are sufficient to cover six months of chemotherapy in one patient using the most expensive commercially available implantable port. Acco rding to the present study, totally implantable access ports connected to a Groshong catheter are associated with high purchase and insertio n costs, a low complication rate and low maintenance costs. These data support their increasing use in current oncologic medical practice.