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Summary Introduction During the last decade, most studies on totally implanted venous access-associated adverse events (TIVA-AE) were conducted retrospectively and/or were based on a limited sample size. The aim of our survey was two-fold: to estimate the incidence of TIVA-AE and to identify risk factors in patients with cancer. Methods Data from our routine surveillance of TIVA-AE were collected prospectively between October 2009 and January 2011 in two oncology referral centers in Northern France. The open cohort under surveillance during the same time period was reconstituted retrospectively using data from the hospital information systems. Incidences of first TIVA-AE per 1000 TIVA-days were calculated. Risk factors were identified using multivariate logistic regressions. Results We included 2286 cancer patients, corresponding to 582,347 TIVA-days. Among the 133 first TIVA-AE observed (incidence 0.23 per 1000 TIVA-days [0.19–0.27]), there were 50 infectious AE (incidence 0.09 [0.06–0.11]) and 83 non-infectious AE (incidence 0.14 [0.11–0.17]). Compared to non-metastatic solid cancers, metastatic cancers (aOR = 2.3 [0.9–6.0]), and hematologic malignancies (aOR = 3.2 [1.1–8.8]) tended to be associated with a higher risk of infectious TIVA-AE (P = 0.087). Solid cancer type was associated with non-infectious TIVA-AE (P = 0.030), especially digestive cancers. Discussion We report accurate estimations of TIVA-AE incidences in one of the largest populations among previously published studies. As in previous studies, metastatic cancers and hematologic malignancies tended to be associated with a higher risk of infectious TIVA-AE. Further studies are warranted to confirm the effect of digestive cancers.

Objectif : Notre objectif etait de construire, a partir du Programme de medicalisation des systemes d’information (PMSI), un indicateur de suivi des delais d’initiation de la chimiotherapie (CT) adjuvante pour cancer du colon et de l’evaluer. Materiel et methodes : A partir du PMSI au CHU de Rouen, nous avons calcule le delai entre la colectomie pour cancer du colon et la CT, chez des patients hospitalises entre 2009 et 2015. Par comparaison au dossier medical, nous avons identifie les vrais et les faux positifs, et nous avons calcule la valeur predictive positive (VPP) de notre methode. Resultats : Parmi les 102 patients selectionnes, la VPP etait de 91 % (IC 95 % : [86–97]). Conclusion : La qualite de l’indicateur meriterait d’etre confirmee dans d’autres etablissements. Applique aux bases PMSI nationales, il pourrait servir d’outil de pilotage au sein des agences regionales de sante et de l’Institut national du cancer.

Summary Introduction Totally implanted venous access (TIVA) improves the safety and welfare of patients treated with cancer chemotherapy (CCT). We aimed to evaluate patients’ perception of TIVA placement, TIVA use, and information on TIVA, and to assess the association between patients’ perception and their attitude regarding a potential TIVA re-implantation. Methods We conducted a single center cross-sectional survey in a university hospital in Northern France. Patients included were consecutive urologic or digestive cancer inpatients admitted for a CCT cycle via TIVA between April 9th and May 9th 2014. We analyzed patients’ satisfaction, experience, and attitude, especially when requiring potential TIVA re-implantation under local anesthesia (LA), using a standardized questionnaire and medical records. We analyzed risk factors for refusing potential TIVA re-implantation under LA using multivariate logistic regression. Results Eighty-one patients were interviewed (no refusals), including 57 with a TIVA device placed under LA in our university hospital. Among them, 52/57 (91%) reported satisfactory TIVA placement, but respectively 21/57 (37%) and 18/57 (32%) complained of painful or uncomfortable TIVA placement; 51/57 (89%) were satisfied with care provided during CCT cycles. Risk factors for refusing potential re-implantation under LA were: TIVA placement considered painful (P = 0.012) or uncomfortable (P = 0.038) and dissatisfaction with care provided during CCT cycles (P = 0.028). Discussion We show that despite good overall satisfaction regarding TIVA, some aspects were less positive and warrant improvement actions. It suggests that these actions could not only improve patients’ experience of TIVA use but could also facilitate continuation of treatment in the long term.

Introduction We aimed to assess the association between a patient’s social status and the cost of stay for a single uncomplicated vaginal delivery. Currently, few data have been reported. Material and methods We conducted an observational study with data retrieved from the medical and administrative databases of a university hospital in North-West France. We included all patients admitted in 2014 and classified in either Diagnosis-Related Group (DRG) « Single uncomplicated vaginal deliveries in a primiparous patient » or DRG « Single uncomplicated vaginal deliveries in a multiparous patient ». Criteria defining poor social status were: a specific healthcare benefit in relation to low income or for foreign undocumented patients, and/or a consultation with a social worker during the hospital stay except if no social problem was diagnosed. We compared the cost of stay between patients with poor social status and patients with good social status using a multivariate median regression stratified on parity, and adjusted for age, gestational age and neonatal hospitalization. Results Among 686 primiparous patients, 21% had poor social status, which was associated with an increase in the median cost of stay (+€475; 95% CI [+334 to +616]), mostly explained by a 1-day increase in the median length of stay.Among 899 multiparous patients, 29% had poor social status, which was not associated with the cost of stay. Discussion Social status had an impact on the cost of vaginal deliveries in primiparous patients. Our findings suggest a need to redefine the DRG classification according to patients' social status.