Elsevier

Journal of Surgical Education

Volume 76, Issue 1, January–February 2019, Pages 182-192
Journal of Surgical Education

ORIGINAL REPORTS
The Safety Level of Total Central Venous Access Port Implantation Performed by Residents

https://doi.org/10.1016/j.jsurg.2018.07.005Get rights and content

OBJECTIVE

The implantation of totally implantable venous access ports (TIVAPs) is one of the first procedures surgical residents learn. Complications after implantation procedures have a major impact on patient outcomes, as it may lead to a delay of chemotherapy regimens or of parenteral nutrition. The aim of this study was to compare the outcomes after totally implantable venous access ports implantations done by resident and attending surgeons.

DESIGN

The study was performed as a retrospective analysis.

SETTING

The study took place in primary care at the Department of General and Visceral Surgery at Frankfurt University Hospital.

PARTICIPANTS

A total of 760 primary totally implantable venous access ports implantations performed between March 2008 and December 2016 were included in a database.

Three groups of surgeons doing the implantations were defined: Group A (residents alone), Group B (resident with help), and Group C (attending surgeons).

RESULTS

There was a significant difference between the surgeon groups in operation time (p < 0.001). The groups differed between Group A (mean, 49; SD, 22) and Group C (mean, 39; SD, 20); p < 0.001) and Group B (mean, 53; SD, 23) and Group C (mean, 39; SD, 20; p < 0.001). The incidence of surgical site infections between Groups A and C (3.6% vs. 0.3%; p = 0.003) and Groups B and C (2.5% vs. 0.3%; p = 0.027) differed also significantly.

Based on multivariable logistic regression analysis operation time in minutes (OR, 1.04; 95%CI, 1.03-1.06; p < 0.001) was an independent risk factor for any intraoperative complications. For any postoperative complications younger age of the patient (OR, 0.98; 95%CI, 0.97-0.99; p = 0.004) and benign primary disease (OR, 3.25; 95%CI, 1.55-6.64; p = 0.002) were independent risk factors based on multivariable regression analysis. Based on multivariable regression analysis a lower body mass index of the patient (OR, 0.93; 95%CI, 0.86-0.99; p = 0.044), benign primary disease (OR, 2.89; 95%CI, 1.07-7.79; p = 0.036), and no chemotherapy (OR, 3.55; 95%CI, 1.50-8.39; p = 0.004) were independent risk factors for postoperative catheter infections. Surgeon group was no risk factor, neither for intraoperative and postoperative complications, nor for catheter explantation due to complications.

CONCLUSION

Residents performing alone or residents performing with help can safely handle a central venous access port implantation. In patients with several risk factors, however, an attending should assist.

Section snippets

INTRODUCTION

Because of the provision of substantial resources, operation time in university hospitals is much more expensive per minute compared with a regional or community hospital. Therefore, basic surgical procedures often create a controversial situation, given their importance for additional surgical education, as university hospitals educate a significant number of residents. Totally implantable venous access ports (TIVAPs) represent one of these procedures, although it is necessary to be taught.1, 2

METHODS

All TIVAP implantations were performed between March 2008 and December 2016 in the Department of General and Visceral Surgery of the University Hospital Frankfurt, and were included in a retrospective database.

RESULTS

Between March 2008 and December 2016, there were 799 TIVAP implantations in our clinic. After exclusion of reimplantations, 760 cases were analyzed (Figure).

DISCUSSION

This retrospective analysis shows postoperative results after TIVAP implantations performed by residents in comparison to attending surgeons. It revealed that TIVAP implantations can be safely done by residents. Nevertheless, there are differences between attending surgeons and residents performing TIVAP implantations. Attending surgeons and consultants demonstrated a significantly shorter operative time and a lower rate of SSI. But no significant differences were found for major complications,

CONCLUSION

TIVAP implantation is a surgical procedure requiring basic skills: It has a low overall complication rate; although major, life-threatening complications can occur. This study reveals that TIVAP implantations by surgical residents are safe and can be used as a training procedure without putting patients at risk of severe complications.

ACKNOWLEDGMENTS

The authors would like to thank Mr. Ulrich Forster from the Communication, Information and Media Center of the University of Hohenheim, for reviewing the statistical analyses and helping with further improvements.

AUTHOR CONTRIBUTIONS

All authors made substantial contributions to the design and analysis of this work, which included drafting and assessing the manuscript. All authors approved the final manuscript for submission and agreed to be accountable for the work.

REFERENCES (19)

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Funding: None.

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