A decision tree to guide long term venous access placement in children and adolescents undergoing surgery for renal tumors

Background/Purpose: While many children with renal tumors require long term venous access (VA) for adjuvant chemotherapy, certainly not all do. This study develops and tests a VA decision tree (DT) to direct the placement of VA in patients with renal tumors. Methods: Utilizing data readily available at surgery a VADT was developed. The VADT was tested retrospectively by 2 independent reviewers on a historic cohort. The ability of the VADT to appropriately select which patients would benefit from VA placement was tested. Results: 160 patients underwent renal tumor surgery between 2005 and 2018. 70 (43.8%) patients met study criteria with median age of 45.1 months (range 1.1–224); 73% required VA. Using the VADT, VA placement was “needed” in 67.1% of patients and “deferred” in 32.9%. Interrater reliability was very high (kappa = 0.97, 95% CI 0.91–1, p < 0.001). The sensitivity and specificity of the VADT to correctly decide on VA placement were 0.92 (0.8–0.98) and 1 (0.79–1). Using the VADT, no patient would have undergone unnecessary VA placement. In reality, 4.3% of patients had an unnecessary VA placed which required a subsequent removal. Conclusions: These preliminary data support the continued study of this VADT to guide intraoperative decisions regarding VA placement in patients with renal tumors. Level of evidence: III — Study of diagnostic test.