A Prospective Quality Of Life Assessment For Surgically Versus Non-Surgically Managed Lymphedema Patients
Pooja S. Yesantharao, MS, Halley Darrach, BS, Sarah Persing, MD, MPH, George Kokosis, MD, Hannah M. Carl, MD, Samantha Stifler, PA, Michelle Seu, BS, Kelly Bridgham, BS, Justin M. Sacks, MD, MBA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Purpose: Lymphedema is a chronic, debilitating condition causing substantial morbidity, but few studies have investigated long-term quality of life (QoL) in lymphedema patients. This study prospectively investigated QoL in surgically and non-surgically managed lymphedema patients.
Methods: This is a longitudinal study of lymphedema patients at a single institution, between February 2017-July 2019. LyQLI and RAND-36 QoL instruments were used. Mann-Whitney-U and Fisher’s Exact tests were used for descriptive statistics. Wilcoxon signed-rank testing and mixed linear modeling were used to analyze QoL longitudinally.
Results: Thirty-two lymphedema surgical candidates were recruited, 20 of whom pursued surgery. Surgical and non-surgical cohorts did not significantly differ in terms of clinical/demographic characteristics or baseline QoL, but at the 12-month timepoint surgical patients had significantly greater LyQLI Overall Health scores than non-surgical patients (79.3 versus 58.3, p=0.02) as well as higher composite RAND-36 Physical (68.5 versus 38.3, p=0.04) and Mental (77.0 versus 52.7, p=0.02) scores. Furthermore, LyQLI Overall Health scores significantly improved over time in surgical patients (60.0 at baseline versus 79.3 at 12 months, p=0.04), corresponding with improvements in disease status demonstrated through postoperative MRI. African American race (p=0.02), older age (p<0.01), and Medicare payer status (p<0.01) negatively impacted QoL upon multivariate modeling, after adjusting for surgical status.
Conclusions: Our results suggest that surgery may improve QoL for chronic lymphedema patients within 12-months post-operatively, in comparison to conservative management.
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