Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

Abstract

Background: The aim of this study is to investigate the impact of the coronavirus disease 2019 (COVID-19) lockdown period on the number and type of vascular procedures performed in the operating theater. Methods: A total of 38 patients who underwent 46 vascular procedures during the lockdown period of March 16th until April 30th, 2020, were included. The control groups consisted of 29 patients in 2019 and 54 patients in 2018 who underwent 36 and 66 vascular procedures, respectively, in the same time period. Data were analyzed using SPSS Statistics. Results: Our study shows that the lockdown during the COVID-19 pandemic resulted in a significant increase in the number of major amputations (42% in 2020 vs. 18% and 15% in 2019 and 2020, respectively; P-value 0.019). Furthermore, we observed a statistically significant difference in the degree of tissue loss as categorized by the Rutherford classification (P-value 0.007). During the lockdown period, patients presented with more extensive ischemic damage when than previous years. We observed no difference in vascular surgical care for patients with an aortic aneurysm. Conclusions: Measurements taken during the lockdown period have a significant effect on noneCOVID-19 vascular patient care, which leads to an increased severe morbidity. In the future, policy makers should be aware of the impact of their measurements on vulnerable patient groups such as those with peripheral arterial occlusive disease. For these patients, medical care should be easily accessible and adequate.

The Effect of COVID-19 on Training and Case Volume of Vascular Surgery Trainees

“…Similar to our findings, Schuivens et al observed more amputations during the COVID-19 lockdown as patients presented with more extensive ischemic disease. 17 Unfortunately, this has shown trainees the time-sensitive nature of limb salvage. While the reduction in skills seen with decreased operating room (OR) time can be ameliorated by increased surgical skills labs, 18 the impact of delayed care for patients has an indelible negative consequence.…”

Health service organisation impact on lower extremity amputations in people with type 2 diabetes with foot ulcers: systematic review and meta-analysis

“…Actionability of the results emerged from this study should also be seen in the perspective of the future organizational evolution of diabetes care after the emergency of the COVID-19 pandemic, which took place well after this study was conceived and conducted. The disruption of care delivery may translate into an increase in LEA rates [ 42 ]. Furthermore, evidence is emerging that people with T2D are at a higher risk of serious complications due to COVID-19 [ 43 ], potentially presenting an opportunity to regard coordinated remote consultations for preventing infections in the household and primary care centers, while enhancing opportunities for multidisciplinary consultation.…”

Response to letter from Verdura et al

“…COVID-19 lock-downs have also affected upstream care of vascular and diabetic patients and resulted in a dramatic increase in the rate of amputations. 2 , 3 Of note, the ARS is particularly useful for the closure of these lower limb amputations, where the rate of wound dehiscence and other complications is over 20%. 4 …”