Neutropenia at the time of subcutaneous port insertion may not be a risk factor for early infectious complications in pediatric oncology patients

J Pediatr Surg. 2019 Jan;54(1):145-149. doi: 10.1016/j.jpedsurg.2018.10.024. Epub 2018 Oct 5.

Abstract

Background: The risk of infection associated with subcutaneous port (SQP) placement in patients with neutropenia remains unclear. We reviewed the rate of early infectious complications (<30 days) following SQP placement in pediatric oncology patients with or without neutropenia [absolute neutrophil count (ANC) <500/mm3].

Methods: Baseline characteristics and infectious complications were compared between groups using univariate and multivariate analyses.

Results: A total of 614 SQP were placed in 542 patients. Compared to nonneutropenic patients, those with neutropenia were more likely to have leukemia (n = 74, 94% vs n = 268, 50%), preoperative fever (n = 17, 22% vs n = 25, 5%), recent documented infection (n = 15, 19% vs n = 47, 9%), and were younger (81 vs 109 months) (p values <0.01). After adjusting for fever and underlying-disease, there was a nonsignificant association between neutropenia and early postoperative infection (OR 2.42, 95% CI 0.82-7.18, p = 0.11). Only preoperative fever was a predictor of infection (OR 6.09, 95% CI 2.08-17.81, p = 0.001).

Conclusion: SQP placement appears safe in most neutropenic patients.

Type of study: Retrospective comparative study.

Level of evidence: Level III.

Keywords: Infection; Neutropenia; Oncology; Pediatric; Venous access.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Catheter-Related Infections / blood
  • Catheter-Related Infections / epidemiology*
  • Central Venous Catheters / adverse effects*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Logistic Models
  • Male
  • Neoplasms / complications
  • Neoplasms / surgery*
  • Neutropenia / complications*
  • Neutrophils
  • Postoperative Complications / blood
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Factors