WOFAPS 2025 8th World Congress of Pediatric Surgery

Andrea Santino Tenorio ¹, Ricardo Escartin Villacampa ¹, Paulina Vargova ², Alvaro Mayordomo Ruiz ², Paolo Bragagnini Rodriguez ¹

¹ Hospital Universitario Miguel Servet, Pediatric Surgical Oncology Unit
² Hospital Universitario Miguel Servet

Objectives
To identify risk factors associated with complications following the placement of totally implantable venous access devices (TIVADs) in pediatric oncology patients.

Materials and Methods
An analytical, retrospective study was conducted on 139 patients aged 0–15 years who underwent TIVAD placement between 2018 and 2022. Descriptive statistics summarized demographic and clinical variables.Associations between potential risk factors and TIVAD-related complications were analyzed using the Chi-square or Fisher’s test. Relative Risks (RR) with 95% confidence intervals (CI) were calculated.A multivariate logistic regression model was performed to identify independent predictors of complications.Statistical significance was set at p<0.05.

Results
TIVADs were placed at a mean patient age of 75.5 months, 55.4% being male and 44.6% female.Complications occurred in 36 cases (25.8%), with surgical site infection being the most common (10 cases, 7.2%).Intraoperative complications were reported in 5 cases (3.6%), and device removal was required in 15 cases (10.7%).

Bivariate analysis revealed significant associations between complications and leukemia diagnosis (p = 0.002; RR = 1.30; 95% CI: 1.12–1.71), asparaginase use (p = 0.002; RR = 1.38; 95% CI: 1.10–1.41), and exposure to antitumor antibiotics (p = 0.003; RR = 1.35; 95% CI: 1.13–1.61). Prior TIVAD placement showed a trend toward increased early complications (p = 0.05).

Multivariate logistic regression identified younger age at TIVAD placement as an independent predictor:each additional month of age reduced complication odds by 4% (OR = 0.96; p = 0.010; 95% CI excluding 1). Use of alkylating agents demonstrated a borderline association with complications (OR = 14.43; p = 0.079), suggesting potential clinical relevance.

Conclusions
TIVAD placement is not devoid of complications.Younger patient age and underlying oncologic diagnosis are independent predictors of adverse outcomes.Exposure to certain chemotherapeutic agents further increases this risk.These findings highlight the importance of tailored preventive strategies and standardized management protocols.