Clinical Question

Does compression reduce the likelihood of recurrent cellulitis in people with chronic leg edema?

Bottom Line

Adding compression to patient education reduces the likelihood of recurrent cellulitis in patients with chronic leg edema. (Level of Evidence = 1b−)

Synopsis

The researchers screened 183 adults and ultimately identified 84 who met their inclusion criteria. The included patients had edema for at least three months and had experienced two or more episodes of cellulitis in the same leg during the previous two years. People 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 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. It is not clear if the diagnosing physician was masked to the intervention. Groups were balanced at baseline: the mean age was 64 years, 49% were women, and 63% had edema for more than five 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 = 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 in the intervention group, although broader quality-of-life scores did not improve.

Study design: Randomized controlled trial (nonblinded)

Funding source: Foundation

Allocation: Unconcealed

Setting: Inpatient (any location)

Reference: Webb E, Neeman T, Bowden FJ, et al. Compression therapy to prevent recurrent cellulitis of the leg. N Engl J Med. 2020;383(7):630–639.

Editor's Note: Dr. Ebell is deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell.