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UNC Lineberger’s Yemi Ogunleye, MD, SM.

In the Journal of Surgical Oncology, UNC Lineberger’s Yemi Ogunleye, MD, SM, and colleagues from UNC published findings from a study that analyzed hospitalizations due to lymphedema with the goal to identify factors associated with poor outcomes.

They performed a retrospective analysis of the Healthcare Cost and Utilization Project National Inpatient Sample for lymphedema-related hospitalizations from 2012 to 2017. All adults admitted with a primary diagnosis of lymphedema or a primary diagnosis of extremity cellulitis and secondary diagnosis of lymphedema were included.

There were an estimated 165,055 lymphedema admissions in the United States between 2012 and 2017. The vast majority of hospitalizations were for cellulitis (92%), lower extremity disease (88%), and were admitted through the emergency room (77%). Median length of stay was 3.61 days and inpatient mortality was 0.03%.

Lymphedema is caused by a build-up of lymph fluid in tissue and results in abnormal swelling in the body – often in the arms or legs. A healthy lymphatic system circulates fluid and cells throughout the body to fight infection. When it is damaged, such as by cancer treatment or a health issue, the lymphatic system may not drain fluid as effectively, or at all. This can cause the tissue fluid to collect in soft tissue and result in limb swelling.

Although mortality is low, the authors noted that lymphedema-related hospitalizations are a significant burden to the U.S. healthcare system. Also, their study found a significant increase in lymphedema hospitalizations during the between 2012 and 2017, from 26,625 to 28,105. During this same period of time, estimated all-cause hospitalizations in the U.S. decreased from 36.4 million to 35.7 million.

The researchers said the increase in lymphedema hospitalizations is likely due to more people surviving their cancer treatment. This suggests, they added, that there is a need to increase training in lymphedema therapy and surgical techniques. Also, counseling older lymphedema patients with comorbidities on early symptoms and signs of infection and prompt treatment of same may reduce mortality.

“The clinical implications of this study are that lower limb lymphedema patients will benefit from conservative and surgical treatments and surveillance or early diagnosis of cellulitis to prevent hospitalization,” Ogunleye said. “Those with comorbidities and who are older than 80 years will also require prompt treatment to prevent mortality.”