At Goulburn Valley Health, a regional Australian general surgery unit, a retrospective observational study spanning January 2019 to December 2024 evaluated 127 totally implantable venous access port (TIVAP) insertion episodes to compare open venous cutdown with the Seldinger technique, as Cureus reported.
Retrospective Analysis of Regional Surgical Outcomes
The six-year review captured adult patients undergoing TIVAP or port-a-cath insertion to establish procedural and postoperative outcomes between the two approaches. Of the 127 total insertion episodes examined, 42 procedures, accounting for 33.1%, utilized open venous cutdown. Meanwhile, 85 procedures, or 66.9%, relied on the Seldinger technique.
Surgical practice shifted notably across the study window. Open cutdown accounted for just 1.7% of procedures between 2019 and 2022, but climbed to 59.4% of insertions during the 2023-2024 timeframe.
Comparing Procedural Success Across Techniques
First-attempt success reached 88.1% for open cutdown and 82.4% for the Seldinger group, yielding an unadjusted odds ratio of 1.58 with a 95% confidence interval spanning 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.
Initial vein selection closely tracked the chosen methodology. 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.
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.
Unplanned removals within one year occurred in 14.1% of the Seldinger group compared to 0% following open cutdown, yielding a p-value of 0.008. However, sensitivity analyses adjusted for calendar year using Firth’s penalised logistic regression. Restricting the analysis to procedures performed during 2023-2024.
Unresolved Variables in Regional Port Insertions
The Goulburn Valley Health Human Research Ethics Committee approved the study under reference QA/120915/GVH-2025-499431[v3] on September 9, 2025, waiving individual informed consent due to the retrospective design. Because insertion technique and calendar period were heavily intertwined—with open cutdown concentrated heavily in the final two years—the independent effect of the insertion technique itself remains undetermined from these retrospective figures.
