Abstract:With the aggressive resource conservation necessary to face the COVID-19 pandemic, vascular surgeons face unique challenges to managing the health of their high-risk patients. Early analysis of patient outcomes following pandemic-related practice changes suggest that patients with chronic limb threatening ischemia (CLTI) have been presenting with more severe foot infections and are more likely to require major limb amputation compared to 6 months prior. As our society and health care system adapt to the new ch… Show more
“…major or minor amputations during the pandemic period attributed to predominantly ischemic ulcers or non infected DFU [23][24][25]. The amputation rates in our study was significantly less as compared to that observed by Caruso P, et al [21] and Schmidt et al [22] despite the inclusion of patients with active DFU (either ischemic or neuropathic) with or without DFI.…”
Section: Plos Onecontrasting
confidence: 57%
“…Another study observed a similar number (24.25%) of minor amputation following foot ulcers during COVID-19 pandemic compared to (20.5%, p>0.05) pre-pandemic period [ 22 ]. Other authors have also noticed an increased rates of major or minor amputations during the pandemic period attributed to predominantly ischemic ulcers or non infected DFU [ 23 – 25 ]. The amputation rates in our study was significantly less as compared to that observed by Caruso P, et al [ 21 ] and Schmidt et al [ 22 ] despite the inclusion of patients with active DFU (either ischemic or neuropathic) with or without DFI.…”
Aims
Limb and patient outcomes in people with diabetic foot complications including diabetic foot ulcer (DFU) provided virtual triage and personalized video consultations during COVID-19 pandemic are not known.
Methods
Patients with foot complications attending the diabetic foot clinic prior to lockdown who sought teleconsultations during COVID-19 lockdown underwent virtual triage to include clinical history, visual inspection of feet, domiciliary wound care (community nurse assisted dressings) and offloading instructions. The subsequent ulcer, limb and mortality outcomes during the following 24 weeks of COVID-19 lockdown (April-September 2020, group 1) were assessed and compared with those who attended foot clinic during the same period in 2019 (April-September, group 2).
Results
Group 1 included 561 participants with foot complications provided with teleconsultations, median age 57 (51 to 63) years and diabetes duration of 10 (5 to 16) years. Twelve patients with severe DFU were excluded and 549 patients [357 (65%) neuropathic foot, 104 (18.9%) ischemic foot and 88 (16%) chronic Charcot foot with deformities] were evaluated. There were 227 (41.3%) participants with active DFU at start of lockdown, 32 (5.8%) with new onset ulcer during lockdown (47.1%) and 290 patients without ulcers. Group 2 included 650 participants; active foot ulcer was present in 366 patients. Wound closed or reduced in area in 78.4% of participants of group 1 compared to 76.0% (p = 0.318) in group 2. Fourteen (5.4%) patients required amputations [3 major and 11 minor] in group 1 during the study period compared to 6.8% in group 2 (p = 0.191). Twenty-one (3.8%) and 28 (4.3%) patients died (p = 0.532) during 24 weeks of follow up in group 1 and 2, respectively.
Conclusions
Targeted foot-care service through virtual triage and teleconsultations during COVID-19 pandemic for people with foot complications have similar ulcer and limb outcomes compared to face-to-face foot care delivery.
“…major or minor amputations during the pandemic period attributed to predominantly ischemic ulcers or non infected DFU [23][24][25]. The amputation rates in our study was significantly less as compared to that observed by Caruso P, et al [21] and Schmidt et al [22] despite the inclusion of patients with active DFU (either ischemic or neuropathic) with or without DFI.…”
Section: Plos Onecontrasting
confidence: 57%
“…Another study observed a similar number (24.25%) of minor amputation following foot ulcers during COVID-19 pandemic compared to (20.5%, p>0.05) pre-pandemic period [ 22 ]. Other authors have also noticed an increased rates of major or minor amputations during the pandemic period attributed to predominantly ischemic ulcers or non infected DFU [ 23 – 25 ]. The amputation rates in our study was significantly less as compared to that observed by Caruso P, et al [ 21 ] and Schmidt et al [ 22 ] despite the inclusion of patients with active DFU (either ischemic or neuropathic) with or without DFI.…”
Aims
Limb and patient outcomes in people with diabetic foot complications including diabetic foot ulcer (DFU) provided virtual triage and personalized video consultations during COVID-19 pandemic are not known.
Methods
Patients with foot complications attending the diabetic foot clinic prior to lockdown who sought teleconsultations during COVID-19 lockdown underwent virtual triage to include clinical history, visual inspection of feet, domiciliary wound care (community nurse assisted dressings) and offloading instructions. The subsequent ulcer, limb and mortality outcomes during the following 24 weeks of COVID-19 lockdown (April-September 2020, group 1) were assessed and compared with those who attended foot clinic during the same period in 2019 (April-September, group 2).
Results
Group 1 included 561 participants with foot complications provided with teleconsultations, median age 57 (51 to 63) years and diabetes duration of 10 (5 to 16) years. Twelve patients with severe DFU were excluded and 549 patients [357 (65%) neuropathic foot, 104 (18.9%) ischemic foot and 88 (16%) chronic Charcot foot with deformities] were evaluated. There were 227 (41.3%) participants with active DFU at start of lockdown, 32 (5.8%) with new onset ulcer during lockdown (47.1%) and 290 patients without ulcers. Group 2 included 650 participants; active foot ulcer was present in 366 patients. Wound closed or reduced in area in 78.4% of participants of group 1 compared to 76.0% (p = 0.318) in group 2. Fourteen (5.4%) patients required amputations [3 major and 11 minor] in group 1 during the study period compared to 6.8% in group 2 (p = 0.191). Twenty-one (3.8%) and 28 (4.3%) patients died (p = 0.532) during 24 weeks of follow up in group 1 and 2, respectively.
Conclusions
Targeted foot-care service through virtual triage and teleconsultations during COVID-19 pandemic for people with foot complications have similar ulcer and limb outcomes compared to face-to-face foot care delivery.
“…Similar findings were noted in Italy, correlating with rapid and critical worsening of diabetic foot infections, as well as in the Netherlands where significantly more major amputations occurred in 2020 than in the previous 2 years in patients with critical limb-threatening ischemia. 19,20 Lancaster and colleagues 21 saw a similar increase in foot infections and an increase in the ratio of major to minor amputations, with a threefold increase in major amputations from pre-pandemic levels.…”
Section: It Has Not Been Typeset and Is Not A Final Versionmentioning
Background: Along with significant case transmission, hospitalizations, and mortality experienced during the global Sars-CoV-2 (COVID-19) pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a level-one trauma center in Central Ohio. Methods: A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and divided into pre-pandemic (n = 120) and pandemic groups (n = 150). Demographics, medical history, severity of current infection, and medical or surgical management were collected and analyzed.Results: The odds of undergoing any level of amputation was 10.8 times higher during the pandemic versus before the pandemic. The risk of major amputations (below-the-knee or higher) likewise increased with an odds ratio of 12.5 among all patients in the foot and ankle service during the pandemic. Of the patients undergoing any amputation, the odds for receiving a major amputation was 3.1 times higher than before the pandemic. Additionally, the severity of infections increased during the pandemic and a larger proportion of the cases were classified as emergent in the pandemic group compared to the pre-pandemic group.Conclusions: The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes-related foot problems resulting in more severe infections, more emergencies, and necessitating more amputations. When an amputation was performed, the likelihood it was a major amputation also increased.Editor's Note: This Original Article accompanies "Diabetes-Related Amputations: A Pandemic within a Pandemic," by Lee C. Rogers, DPM, Robert J. Snyder, DPM, and Warren S. Joseph, DPM, FIDSA, available at https://doi.org/10.7547/20-248
“…Notably, the only procedure that increased during this period was major amputation (7%; 95% CI, 0%-14%), potentially owing to delays in presentation and treatment for peripheral artery disease and diabetic foot complications. [4][5][6] After resumption of surgical services, we observed a significant increase in vascular procedures; however, the total volume remained 14% (95% CI, 13%-15%) lower than in 2019 (Fig, B). Ruptured aneurysm cases increased by 2.4fold, whereas carotid stenting increased by 74% (95% CI, 63%-85%) at the expense of carotid endarterectomy (22%; 95% CI, e17% to e27%).…”
mentioning
confidence: 99%
“…Notably, the only procedure that increased during this period was major amputation (7%; 95% CI, 0%-14%), potentially owing to delays in presentation and treatment for peripheral artery disease and diabetic foot complications. 4 , 5 , 6 Fig Trends in vascular procedures performed at Mass General Brigham during (A) and after the first COVID-19 wave (B) relative to the same periods in 2019. Caption: ∗O: E represents numbers of observed to expected procedures during the study period.…”
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
