Tang Linnan, Kim Charles Y, Martin Jonathan G, Pabon-Ramos Waleska M, Sag Alan A, Suhocki Paul V, Smith Tony P, Ronald James
Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710.
Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710.
J Vasc Interv Radiol. 2020 Mar;31(3):454-461. doi: 10.1016/j.jvir.2019.10.017. Epub 2020 Jan 29.
To compare early totally implantable central venous port catheter-related infection rates after inpatient vs outpatient placement and to determine whether the risk associated with inpatient placement is influenced by length of hospital stay.
In this single-institution retrospective study, 5,301 patients (3,618 women; mean age 57 y) underwent port placement by interventional radiologists between October 2004 and January 2018. The 30-day infection rate was compared between inpatients and outpatients using survival analysis. Among inpatients, the effect of time from admission to port placement and from placement to discharge was analyzed using a survival regression tree.
The 30-day infection rate was 3.6% (95% confidence interval [CI] = 1.9%-6.1%) among 386 inpatients and 1.0% (95% CI = 0.7%-1.3%) among 4,915 outpatients (hazard ratio [HR] = 3.6, 95% CI = 2.0-6.6, P < .001). Inpatient placement was a significant risk factor after accounting for covariates in multivariate analysis (HR = 2.2, 95% CI = 1.0-4.7, P = .05) and controlling for demographic differences by propensity score matching (HR = 2.8, 95% CI = 1.0-7.8, P = .04). Infection rate was 11% (95% CI = 4.7%-22%) among 65 inpatients in whom time from admission to placement was ≥ 7 days, 5.1% (95% CI = 1.9%-11%) among 129 inpatients in whom admission to placement was < 7 days and time to discharge was > 3 days, and 0% (95% CI = 0%-2.1%) among 192 inpatients in whom admission to placement was < 7 days and time to discharge was ≤ 3 days (P < .001).
Inpatient port placement was associated with a higher risk of early infection. However, a clinical decision tree based on shorter length of stay before and after placement may identify a subset of hospitalized patients not at increased risk for infection.
比较住院患者与门诊患者植入完全可植入式中心静脉端口导管后早期感染率，并确定与住院植入相关的风险是否受住院时间长短的影响。
在这项单机构回顾性研究中，2004年10月至2018年1月间，5301例患者（3618例女性；平均年龄57岁）接受了介入放射科医生进行的端口植入。使用生存分析比较住院患者和门诊患者的30天感染率。在住院患者中，使用生存回归树分析从入院到端口植入以及从植入到出院的时间的影响。
386例住院患者的30天感染率为3.6%（95%置信区间[CI]=1.9%-6.1%），4915例门诊患者的感染率为1.0%（95%CI=0.7%-1.3%）（风险比[HR]=3.6，95%CI=2.0-6.6，P<.001）。在多变量分析中考虑协变量并通过倾向得分匹配控制人口统计学差异后，住院植入是一个显著的风险因素（HR=2.2，95%CI=1.0-4.7，P=.05）（HR=2.8，95%CI=1.0-7.8，P=.04）。从入院到植入时间≥7天的65例住院患者中，感染率为11%（95%CI=4.7%-22%），入院到植入时间<7天且出院时间>3天的129例住院患者中，感染率为5.1%（95%CI=1.9%-11%），入院到植入时间<7天且出院时间≤3天的192例住院患者中，感染率为0%（95%CI=0%-2.1%）（P<.001）。
住院患者植入端口与早期感染风险较高相关。然而，基于植入前后较短住院时间的临床决策树可能识别出感染风险未增加的住院患者亚组。
