Goulburn Valley Health Retrospective Evaluates 127 TIVAP Procedures
A retrospective observational study conducted at Goulburn Valley Health, a regional Australian general surgery unit, evaluated 127 totally implantable venous access port insertion episodes between January 2019 and December 2024, Cureus reported. Researchers set out to compare procedural and postoperative outcomes between open venous cutdown and the percutaneous Seldinger technique. While investigators initially expected consistent procedural trends across the six-year review window, surgical practice shifted significantly over time, complicating direct outcome comparisons between the two methods.
During the study period, adult patients underwent 127 port-a-cath or totally implantable venous access port insertions. Open venous cutdown accounted for 42 procedures, or 33.1% of the total cohort, while 85 procedures, representing 66.9%, relied on the Seldinger technique, as archyde.com noted. The choice of initial access vein tracked closely with the chosen technique. The cephalic vein served as the primary access site for 97.6% of open cutdown attempts. Conversely, the subclavian vein accounted for 90.6% of Seldinger attempts.
Shifting Surgical Practices and Technique Success Rates
Surgical practice at the regional centre evolved markedly across the six-year span. As archyde.com noted, open cutdown represented a mere 1.7% of interventions from 2019 through 2022, yet rose to comprise 59.4% of placements over the 2023-2024 period. This temporal concentration meant insertion technique and calendar period became heavily intertwined.
Open cutdown achieved an 88.1% initial success rate compared to 82.4% for the Seldinger cohort, resulting in an unadjusted odds ratio of 1.58 alongside a 95% confidence interval reaching from 0.50 to 6.00. Technique conversion rates stood at 9.5% for open cutdown and 7.1% for the Seldinger cohort. Access-site conversion occurred in 4.8% of cutdown procedures compared to 10.6% of Seldinger attempts. Ultimately, all procedures across both groups were successfully completed.
Divergence in Periprocedural and Postoperative Complications
Periprocedural complications appeared exclusively within the Seldinger group. These events comprised four bleeding incidents, four arterial punctures, and a single pneumothorax. No such periprocedural complications were recorded in the open cutdown cohort.
Following open cutdown, 0% of patients experienced unplanned removals within one year, whereas 14.1% of the Seldinger cohort faced such removals, resulting in a p-value of 0.008. However, this statistical significance disappeared after researchers adjusted for calendar year using Firth’s penalised logistic regression or restricted the analysis to procedures performed during 2023 and 2024.
Broader Context in Regional Australian Surgical Units
Comparative evidence regarding TIVAP insertion methods remains mixed across international and regional literature. A separate descriptive, three-year retrospective multicentre study of oncological patients at two peripheral Brisbane hospitals examined insertions performed by general surgeons and radiologists, as noted on PMC. That study found that surgeons achieved an overall success rate of 81.4% across 97 insertions, while radiologists achieved a 99.5% first-attempt success rate across 248 ultrasound-guided internal jugular vein insertions. Similar to the Goulburn Valley Health findings, pneumothorax events in the Brisbane cohort occurred exclusively in association with subclavian cannulation attempts.
Review reference QA/120915/GVH-2025-499431[v3] was formally granted on September 9, 2025, by the Goulburn Valley Health Human Research Ethics Committee, which waived requirements for individual informed consent given the study’s retrospective nature.
Commonly Asked Questions About Regional Port Insertions
Why did the independent effect of the insertion technique remain undetermined?
Insertion technique and calendar period were heavily intertwined, because open cutdown was used almost exclusively during the final two years of the study period.
What specific periprocedural complications occurred during the study?
Periprocedural complications included four bleeding events, four arterial punctures, and one pneumothorax, all of which occurred exclusively in the Seldinger group.
How many unique patients were included in the Goulburn Valley Health review?
The study evaluated 127 insertion episodes involving 117 unique adult patients between January 2019 and December 2024.