Subcutaneous Venous-Access Device Removal

Abstract

INTRODUCTION: Most patients being treated for gynecologic malignancies have vascular-access devices for chemotherapy administration. After treatment is completed, the device is removed. However, the ideal setting for removal has not been shown. This study performed a cost analysis of outpatient-clinic removal with local anesthesia compared with outpatient-operating room removal with various forms of sedation while controlling for postprocedure complications. METHODS: All patients with vascular-access devices removed by physicians from our institution from January 1, 2010, to June 1, 2013, were identified. We matched the number of the solo practitioner's removal in the outpatient setting to one of the provider's in the surgical setting in the hospital. Charges from the outpatient and hospital settings were collected. Using statistical software SPSS, descriptive statistics were used to examine the distributions of patient characteristics for both patient groups. Comparability of the two patient groups as well as any cost differences were examined using t test. RESULTS: Regardless of the setting for removal of the vascular-access device, no differences in complications were seen when controlled for age, body mass index, comorbid status, or cancer stage. However, removing the devices in the outpatient clinical setting was more cost-effective than removing the devices in the operating room ($700 compared with $1,485-3,325, respectively). CONCLUSION: This study is the first economic evaluation of venue for the removal of a vascular-access device; it shows that, not only is the clinic-outpatient location safe, but performing these removals in this setting provides a significant cost savings over the outpatient-operating room location.