Eisner Zachary J, Best Christine S W, Lenders Jayna, Hespe Geoffrey E, Myers Paige L, Kung Theodore A
University of Michigan Medical School, Ann Arbor, MI, USA.
Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA.
Ann Surg Oncol. 2025 Jan;32(1):542-550. doi: 10.1245/s10434-024-16304-7. Epub 2024 Oct 9.
Secondary lymphedema has become an increasingly common reason for referral to plastic surgery. Understanding referral patterns for lymphedema patients is crucial to optimizing care.
Patients referred to plastic surgery for lymphedema at a lymphatic surgery center between January 2016 and 2023 were identified. Primary outcomes of interest included clinical lymphedema staging and characteristics, patient demographics, and referral sources. Secondary outcomes were prior lymphedema treatment, agreement between referring provider and plastic surgeon's diagnosis, and patient disposition after surgical evaluation. Descriptive statistics and multivariate logistic regression analysis were performed.
A total of 285 patients with extremity edema were referred to plastic surgery; 60.0% of patients had prior malignancy, 45.6% of patients had undergone a prior lymph node procedure, and 40% had received radiation, while 56.8% of patients had previously seen occupational therapy. Body mass index (BMI, OR 1.09, p = 0.013), age (OR 1.25, p = 0.005), and prior physical or occupational therapy (OR 1.23, p = 0.011) were associated with later stages of lymphedema upon presentation, while prior radiation (OR 0.79, p = 0.006) and malignancy (OR 0.85, p = 0.034) were associated with earlier stages of lymphedema. Self-referral (27.4%), primary care (17.9%), and medical oncology (14.7%) were the most common referral sources. Lymphedema was confirmed in 68.1% of referrals, and 28.5% of these patients proceeded to surgery. Patients were more likely to be operative candidates if referred by primary care (RR 2.1, p = 0.006) or occupational therapy (RR 4.6, p = 0.010).
Referred patients ultimately undergo lymphedema surgery at relatively low rates, indicating that most referred patients are not ideal surgical candidates. Optimizing referral patterns through multidisciplinary education may enhance the referral process and improve access to lymphedema surgery.
继发性淋巴水肿已成为转诊至整形外科的一个日益常见的原因。了解淋巴水肿患者的转诊模式对于优化治疗至关重要。
确定了2016年1月至2023年期间在一家淋巴外科中心因淋巴水肿转诊至整形外科的患者。感兴趣的主要结局包括临床淋巴水肿分期及特征、患者人口统计学信息和转诊来源。次要结局为既往淋巴水肿治疗情况、转诊医生与整形外科医生诊断的一致性以及手术评估后的患者处置情况。进行了描述性统计和多变量逻辑回归分析。
共有285例肢体水肿患者转诊至整形外科；60.0%的患者既往有恶性肿瘤病史，45.6%的患者既往接受过淋巴结手术，40%接受过放疗，而56.8%的患者此前看过职业治疗师。体重指数（BMI，比值比1.09，p = 0.013）、年龄（比值比1.25，p = 0.005）以及既往接受过物理或职业治疗（比值比1.23，p = 0.011）与就诊时淋巴水肿的晚期阶段相关，而既往放疗（比值比0.79，p = 0.006）和恶性肿瘤（比值比0.85，p = 0.034）与淋巴水肿的早期阶段相关。自我转诊（27.4%）、初级保健（17.9%）和医学肿瘤学（14.7%）是最常见的转诊来源。68.1%的转诊病例确诊为淋巴水肿，其中28.5%的患者接受了手术。如果由初级保健医生（相对危险度2.1，p = 0.006）或职业治疗师转诊（相对危险度4.6，p = 0.010），患者更有可能成为手术候选人。
转诊患者最终接受淋巴水肿手术的比例相对较低，这表明大多数转诊患者并非理想的手术候选人。通过多学科教育优化转诊模式可能会改善转诊流程并增加获得淋巴水肿手术的机会。
