Breakdown of Diabetic Foot Ulcer Care during the First Year of the Pandemic in Poland: A Retrospective National Cohort Study

Abstract

The COVID-19 pandemic revealed a breakdown of the system of DFU patient care. This retrospective national cohort study analyses the epidemiological status of DFU patients in relation to urgent and elective hospitalizations, amputation rates, and deaths in Poland from 2017 to 2019, and during 2020 when the COVID-19 pandemic began. The data were obtained from national medical records gathered by the National Health Fund (NHF). Discharge diagnoses were categorized according to ICD-10 and ICD-9 codes. Analysis of the data showed a statistically significant decrease in elective hospital admissions (from 29.6% to 26.3%, p = 0.001). There was a decrease in the percentage of hospitalizations related to limb-salvage procedures (from 79.4% to 71.3%, p = 0.001). The opposite tendency was observed among urgent hospital admissions (from 67.0% to 73.2%, p = 0.01), which was related to a significant increase in the number of minor amputations (from 3146 to 4269, p = 0.017). This rise was in parallel with the increase in the percentage of patients who died during hospitalization due to DFU (from 3.9% to 4.8%, p = 0.03). The number of deaths has not changed significantly (from 590.7 to 668.0, p = 0.26). The results of the conducted analyses confirm the negative tendencies in the medical care of patients with DFU during the first year of the pandemic in Poland. Changes in therapy schemes and stronger patient support following this period are necessary to avoid further complications in patients with DFU.

Diabetic foot disease during the COVID-19 pandemic: lessons learned for our future

“…In Poland, Kleibert et al [ 45 ] reported an increase in the total number of DFU amputations compared to the pre-COVID era. In particular, the authors did not observe a decrease in the number of majors amputations (above the knee) and simultaneously an increase in minor amputations (below the ankle).…”

“…The first reports during the lockdown were limited to small cohorts of single specialized centers which showed different results [24,39,40,43,[47][48][49][50][51][52], while subsequently several complete population studies have been published [42,[44][45][46]56].…”

“…In many studies, the increase of amputations has been attributed to the severity of the infection and delayed referral [24,39,47,48,50,55] while in several studies the lower rate of major amputations may be due to a lower incidence of ulcers [42][43][44][45]56] due to reduced mobility in the context of home confinement, although reliable data on the incidence of ulcers are not available. In addition, data relating to minor amputations could be underestimated because during the first wave of the pandemic many minor ampu-tations were performed in the outpatient clinic due to the unavailability of operating rooms [41].…”

Efficacy of telemedicine applications in patients with diabetic foot ulcers: A focus on mortality and major amputation rates

“…This characteristic of our study was also harmonious with the literature. [4][5][6] During the pandemic period, more people who required any level of amputation had end-stage renal disease and vascular disease. This difference may be a result of lacking analyses and physical examination in telemedicine settings.…”

The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future

“…The COVID-19 pandemic posed major challenges in DFU care across the globe due the above reasons[ 9 - 11 ]. Delays in ulcer reviews may be associated with detrimental effects on DFU healing that may even lead to amputations[ 10 , 11 ].…”