Delivery of CareSurgeon, not technique, defines outcomes after central venous port insertion

BackgroundAlthough central venous access for port placement is common and relatively safe, complications and poor resource utilization occur. We hypothesized that despite the simplicity of port placement, surgeon and/or resident performance-rather than technique-is associated with clinical outcomes and operating room efficiency.Materials and methodsMedical records of 1200 patients who underwent port placement between 2012 and 2015 at our institution were retrospectively reviewed. Insertion route (subclavian, internal jugular, cephalic cutdown), individual surgeon (A-G), surgeon volume, body mass index, patient age, and resident presence were evaluated to determine their association with operating room time, complications, and need for alternate insertion route.ResultsOn univariate analysis, operating room times were significantly different among individual surgeons, with surgeons E and F having the longest operating room times (50 and 63 versus 31-40 min; P < 0.01) and switching to an alternate method more frequently (13.5% and 21.3%, versus 0%-10.3%, P < 0.01). On multivariate analyses, operating time was increased with elevated body mass index, resident presence, and switching to an alternate method. Individual surgeons had varied effects on operating time with two surgeons found to be the predominant drivers (OR 19 and 27; P < 0.01). With residents excluded, these two surgeons continued to increase operating times (OR 15 and 29; P < 0.01) and procedural complications (OR 3.2 and 5.9; P < 0.05).ConclusionsAlthough port placement is ostensibly simple, individual surgeon performance is the primary driver of patient outcome and operative efficiency. In an era requiring optimized resource utilization and outcomes, these data demonstrate potential for enhanced programmatic organization and case distribution.