Compression reduces recurrent cellulitis in patients with chronic leg edema

Référence

Webb E, Neeman T, Bowden FJ, Gaida J, Mumford V, Bissett B. Compression therapy to prevent recurrent cellulitis of the leg. N Engl J Med 2020;383(7):630-639.

Sommaire

These researchers screened 183 adults and ultimately identified 84 who met their inclusion criteria. The included patients had edema for at least 3 months and had experienced 2 or more episodes of cellulitis in the same leg during the previous 2 years. Persons who were unstable or receiving end-of-life care, who had a chronic wound requiring ongoing treatment, or who were already wearing compression garments were excluded. Patients were randomized to receive either education only, or education plus a compression garment. The garments were mostly knee-high compression stockings that included the foot but not necessarily the toes. The primary outcome was the number of episodes of recurrent cellulitis, diagnosed by a physician not otherwise involved with the study (although it isn't clear whether the diagnosing physician was masked to the intervention). Groups were balanced at the beginning of the study, with a mean age of 64 years, 49% women, and with 63% having had edema for more than 5 years. Analysis was by intention to treat, and patients were no longer followed after an episode of cellulitis occurred. The trial was stopped early when an interim analysis revealed that episodes of cellulitis were much less common in the compression group (15% vs 40%; P = .002; number needed to treat [NNT] = 4). At that time, the median duration of follow-up was 209 days in the compression group and 77 days in the education-only group. Fewer patients in the compression group were hospitalized for cellulitis (3 vs 6). A lymphedema quality-of-life score also improved more in the intervention group, though broader quality-of-life scores did not improve.