TECHNOLOGY
Tackling the problem of oedema
Andrew Thelwell discusses the burden oedema places on healthcare systems, clinicians and patients and the historic lack of solutions. He provides an insight into a solution that helps reduce complications related to pre and post operative swelling following orthopaedic surgery, trauma and kidney transplant.
Oedema is swelling caused by excess fluid that has leaked from the vascular system and becomes trapped in the body’s tissues. It can affect any part of the body and can impede recovery from illness or operation.1
There are
several different sub-types of oedema – such as pulmonary and cerebral – but this article focuses on peripheral oedema. Oedema can delay early patient
intervention, early discharge and impede patient recovery.2
For the past 10 years,
a major focus for healthcare systems has been to move people out of the hospital environment as quickly as possible. This has three benefits: it means healthcare systems can treat people more quickly; it reduces the cost of hospital stays – one of the most expensive aspects of healthcare; and it enables people to recover in the familiar comfort of their own home.3
This objective,
however, can be negatively impacted by the effect of unresolved oedema.2
As an example, in the trauma setting, consider the impact of oedema on a patient with an ankle fracture. An ideal scenario is to operate as soon as possible after a patient presents at hospital. The earlier the intervention, the better the likely bone repair and the sooner rehabilitation can begin. This ideal, however, is confounded by the presence of initial oedema, which can then increase over the first 24-48 hours post fracture.4 Ankle trauma patients most often arrive
in A&E with oedema build-up already established. In these circumstances, patients who are unable to be sent home to elevate, due to clinical and social circumstances, require in-patient bed rest to elevate the ankle and, therefore, reduce swelling to an acceptable level to operate.5
This scenario
With more urine produced and less fluid retention, patients experienced 31% less oedema and the duration of costly hospitalisation was shortened by more than one day after kidney transplantation, compared to standard care.
AUGUST 2021
can cause bed blocking. Interventions that reduce pre-operative swelling and accelerate readiness to surgery can therefore provide significant benefits to both patients and healthcare providers. This also applies to post-operative oedema management. Patients with comorbidities and compromised vasculature are at greater risk of complications related to swelling following lower limb orthopaedic surgery.6
Impaired calf muscle pump
function, the result of immobility and/or venous insufficiency, can cause ineffective venous return, reducing the delivery of blood to the tissue, impacting surgical wound healing and muscle function.7 Following knee replacement surgery,
post-operative oedema can also block nerve to muscle signals, diminishing quadriceps
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