Comparing central venous access strategies in elderly patients with dysphagia: a survival analysis

Dysphagia in older adults often necessitates long term parenteral nutrition (TPN). However, the optimal central venous access strategy, including implantable central venous access port (ICVAP), non-tunneled central venous catheter (NT-CVC) or peripherally inserted central catheter (PICC), remains uncertain, particularly regarding survival and complication risk.

This retrospective cohort study included 73 patients aged ≥65 years with dysphagia who received parenteral nutrition via ICVAP, NT-CVC, or PICC. Device selection was based on patient/family request and feasibility/acceptability at the discharge destination. Baseline characteristics were compared using ANOVA and chi-square/Fisher's exact tests, and standardized mean differences (SMD) were reported to quantify baseline imbalance. Survival was evaluated using Kaplan-Meier curves with log-rank tests. Multivariable Cox proportional hazards models were performed to adjust for predefined covariates. Short-term mortality and complications were compared using chi-square or Fisher's exact tests.

Survival differed significantly among the three groups (log-rank p < 0.001), with median survival of 305 days for ICVAP, 195 days for PICC, and 43 days for NT-CVC. After adjustment, NT-CVC was associated with a significantly higher mortality risk compared to ICVAP (HR = 4.15, 95% CI: 1.17-14.78, p = 0.028), while no significant difference was observed between PICC and ICVAP (HR = 1.05, 95% CI: 0.36-3.04, p = 0.927). Independent predictors of mortality included advanced age (HR = 1.08, p = 0.004), lower BMI (HR = 0.89, p = 0.034), higher CFS (HR = 3.70, p = 0.027), and total lymphocyte count (TLC) (HR = 1.00, p = 0.009). NT-CVC had the highest short-term mortality (34.6% at 30 days, 73.1% at 90 days, p < 0.05). No significant differences were observed in pneumonia or sepsis rates.

In this cohort of elderly patients with dysphagia receiving long-term parenteral nutrition, ICVAP use was associated with longer survival compared with NT-CVC, while no significant survival difference was observed between PICC and ICVAP. Given the retrospective design and non-random catheter selection, these findings should be interpreted as associations and warrant confirmation in prospective, multicenter studies incorporating standardized complication definitions and patient-centered outcomes.