Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation
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| Titel: | Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation |
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| Autoren: | Klaiber, Ulla, Probst, Pascal, Hackbusch, Matthes, Jensen, Katrin, Dörr-Harim, Colette, Hüttner, Felix J., Hackert, Thilo, Diener, Markus K., Büchler, Markus W., Knebel, Phillip |
| Quelle: | Langenbecks Arch Surg |
| Verlagsinformationen: | Springer Science and Business Media LLC, 2021. |
| Publikationsjahr: | 2021 |
| Schlagwörter: | Catheterization, Central Venous, 03 medical and health sciences, Catheters, Indwelling, 0302 clinical medicine, Humans, Pneumothorax, Systematic Reviews and Meta-analyses, Subclavian Vein, Catheterization, Central Venous/adverse effects [MeSH], Humans [MeSH], Open cut-down, Subclavian Vein [MeSH], Catheters, Indwelling/adverse effects [MeSH], Pneumothorax/etiology [MeSH], Venous access ports (TIVAP), Randomized Controlled Trials as Topic [MeSH], Seldinger technique, Pneumothorax/epidemiology [MeSH], Randomized Controlled Trials as Topic, 3. Good health |
| Beschreibung: | Background There is still no reference standard for the implantation of totally implantable venous access ports (TIVAPs). A recently published multicentre randomised controlled trial (RCT) revealed a significantly greater risk of pneumothorax after closed cannulation than after an open strategy. The aim of this meta-analysis was to provide an update of the available evidence for the safety and effectiveness of primary open versus closed cannulation strategy. Methods RCTs comparing outcomes of open cut-down of the cephalic vein and closed cannulation of the subclavian vein were sought systematically in MEDLINE, Web of Science and CENTRAL. The primary outcome was the occurrence of pneumothorax. A beta-binominal model was applied to combine the respective outcomes, and results are presented as odds ratios (OR) with 95% confidence interval (CI). Results Six RCTs with a total of 1831 patients were included in final analysis. Meta-analysis showed statistically significant superiority of the open cut-down technique regarding pneumothorax (OR 0.308, 95% CI 0.122 to 0.776), but a statistically significant higher failure of the primary technique for the open cut-down technique than for closed cannulation (OR 2.364, 95% CI 1.051 to 5.315). There were no significant differences between the two procedures regarding other morbidity endpoints. Conclusion This meta-analysis shows a general superiority of open cut-down of the cephalic vein over closed cannulation of the subclavian vein regarding the occurrence of pneumothorax. Open cut-down should be the first-line approach for TIVAP implantation. Closed cannulation should be performed with ultrasound as second-line procedure if the open technique fails. Systematic review registration PROSPERO CRD42013005180 |
| Publikationsart: | Article Other literature type |
| Sprache: | English |
| ISSN: | 1435-2451 1435-2443 |
| DOI: | 10.1007/s00423-020-02057-w |
| Zugangs-URL: | https://link.springer.com/content/pdf/10.1007/s00423-020-02057-w.pdf https://pubmed.ncbi.nlm.nih.gov/33420832 https://link.springer.com/content/pdf/10.1007/s00423-020-02057-w.pdf https://www.ncbi.nlm.nih.gov/pubmed/33420832 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106576 https://pubmed.ncbi.nlm.nih.gov/33420832/ https://link.springer.com/article/10.1007/s00423-020-02057-w https://repository.publisso.de/resource/frl:6447060 |
| Rights: | CC BY |
| Dokumentencode: | edsair.doi.dedup.....208f7d667938c65a63d034d5ed7c840b |
| Datenbank: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | Background There is still no reference standard for the implantation of totally implantable venous access ports (TIVAPs). A recently published multicentre randomised controlled trial (RCT) revealed a significantly greater risk of pneumothorax after closed cannulation than after an open strategy. The aim of this meta-analysis was to provide an update of the available evidence for the safety and effectiveness of primary open versus closed cannulation strategy. Methods RCTs comparing outcomes of open cut-down of the cephalic vein and closed cannulation of the subclavian vein were sought systematically in MEDLINE, Web of Science and CENTRAL. The primary outcome was the occurrence of pneumothorax. A beta-binominal model was applied to combine the respective outcomes, and results are presented as odds ratios (OR) with 95% confidence interval (CI). Results Six RCTs with a total of 1831 patients were included in final analysis. Meta-analysis showed statistically significant superiority of the open cut-down technique regarding pneumothorax (OR 0.308, 95% CI 0.122 to 0.776), but a statistically significant higher failure of the primary technique for the open cut-down technique than for closed cannulation (OR 2.364, 95% CI 1.051 to 5.315). There were no significant differences between the two procedures regarding other morbidity endpoints. Conclusion This meta-analysis shows a general superiority of open cut-down of the cephalic vein over closed cannulation of the subclavian vein regarding the occurrence of pneumothorax. Open cut-down should be the first-line approach for TIVAP implantation. Closed cannulation should be performed with ultrasound as second-line procedure if the open technique fails. Systematic review registration PROSPERO CRD42013005180 |
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| ISSN: | 14352451 14352443 |
| DOI: | 10.1007/s00423-020-02057-w |