Institutionalization of reconstructive lymphedema surgery in Austria—Single center experience

Abstract

BackgroundLymphedema surgery was not widely known in Austria before the introduction of lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) in 2014. This study shares the experience and process of establishing and institutionalizing lymphedema surgery service in Austria.MethodsThe purpose of introducing reconstructive lymphedema surgery in Austria was to improve lymphedema patients’ quality of life and provide them surgical therapy as an adjuvant treatment to complete decongestive therapy. To initialize reconstructive lymphedema surgery in Austria, LVA and VLNT had to be presented and introduced, in the manner of branding and advertizing a new product. Surgeries were performed with quality control by standardized documentation, pre‐ and postoperatively.ResultsAligned with branding and marketing, presentations were given externally and internally to share knowledge and experience of lymphedema surgery. Lymphedema surgery service was introduced as a new brand in the medical service in Austria. After several communications with the Austrian Health Insurance Fund and with the final application, LVA and VLNT were listed as novel surgical therapies in its 2020 reimbursement catalog. Since 2014, more than 300 lymphedema patients were consulted, and 102 reconstructive lymphedema surgeries were performed. Circumference reduction of extremities after surgery was between 20% and 43%, postoperatively.ConclusionAcceptance of surgery in lymphedema patients varies among continents, hospitals, and surgeons. Evaluation of the requirement of the surgical setup and insurance conditions for lymphedema surgery is essential to establish lymphedema surgery, providing targeted marketing and branding to spread knowledge of the novel technique and grant patients access to therapeutic treatment of their chronic disease.

Insurance coverage policies for reconstructive lymphatic microsurgery procedures in Switzerland

“…In 2018, they initially recommended a temporary withdrawal of reimbursement for lymphatic microsurgery in Austria. Recently, Tzou et al shared their Austrian experience on how to establish a lymphoedema centre in Europe [16]. In Austria, because of differences in governmental healthcare reimbursement, no mandate is needed for applications for reimbursement for a new surgical lymphoedema therapy [16].…”

“…Their first application for reimbursement in 2018 was rejected, but the next one, in 2019, was approved by the Austrian Health Insurance Fund for listing as novel surgical therapy in its 2020 catalogue. They claim that introducing a new procedure for lymphoedema surgery was like introducing a new brand onto the market and that information played an important role for patients and referrals [16]. They added that the evaluation of lymphoedema patients' perceptions, requirements of the surgical setup, and insurance conditions for lymphoedema surgery are essential to support managerial decisions to promote and institutionalise lymphedema surgery, thereby providing better access for lymphoedema patients to this treatment [16].…”

“…Owing to methodological shortcomings, they could not conclude whether the LVA is at least equally effective and safer than the comparator LTT or conservative treatment, and back then initially recommended a temporary withholding of cost reimbursement. However, after several communications with the Austrian Health Insurance Fund, LVA and LTT were finally listed as novel surgical therapies in the 2020 reimbursement catalogue [16].…”

Long-term Use of Ultrasound for Locating Optimal LVA Sites: A Descriptive Data Analysis

“…Favorable outcomes are reported by numerous investigators regarding volume reduction, improvement of accompanying symptoms, and patient's quality of life. [10][11][12][13][14][15][16][17][18][19] To achieve an optimal result, preoperative mapping of lymphatic vessels is crucial. It can be performed by multiple imaging modalities, most often by near-infrared fluorescent (NIRF) imaging, frequently called indocyanine green (ICG) lymphography.…”

Mikrochirurgische Therapieoptionen beim Lymphödem

“…Der lymphovenöse Bypass oder die lymphovenöse Anastomose erzeugen einen früheren Eingang ins venöse System in der Peripherie dieses Drainagesystems. Durch diese Technik kann ein proximales Abflusshindernis elegant umgangen werden.Die hier beschriebene minimalinvasive, chirurgische Technik sowie der Ablauf und das postoperative Management entsprechen dem Standard der Plastischen und Rekonstruktiven Chirurgie des Göttlicher-Heiland-Krankenhauses Wien, Österreich[16].Hierzu erfolgt zunächst die präoperative Markierung passender Inzisionsstellen mittels ICG-Lymphangiografie in Kombination mit hochauflösendem Ultraschall. Die Hautinzision beträgt üblicherweise eine Länge von wenigen Zentimetern und kann in Abhängigkeit von der Patienten-Compliance in Lokalanästhesie oder Vollnarkose erfolgen.…”