Indirect impact of the COVID-19 pandemic on diabetes-related lower extremity amputations: A regional study

Abstract

The outbreak of severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) was first began in China and led to a global novel coronavirus disease 2019 (COVID-19) pandemic in 2020. [1] As the spread of the pandemic has continued, more than a million deaths were reported due to COVID-19 infection worldwide. [2] Due to the rapid spread of the virus, healthcare systems were exposed to a large number of COVID-19 infection patients which created a potential collapse risk of healthcare systems. [3] Healthcare authorities and governments around the world have made several attempts to overcome the rapid spread of the virus such as lockdowns, school closures, cessation of international transportation. [3] A curfew was announced in Turkey on March 21 st , 2020, for the citizens over the age of 65 years and who had chronic diseases and individuals aged below 20 years. In addition, many businesses Objectives: This study aims to evaluate the indirect impact of the novel coronavirus disease 2019 (COVID-19) pandemic on diabetes-related lower extremity amputations. Patients and methods: Patients who underwent lower limb amputation due to complications of diabetes between August 2019 and February 2020 (control group) and August 2020 and February 2021 (pandemic group) were retrospectively reviewed. None of the patients had a previous COVID-19 infection. Patients' amputation level and latest diabetes follow-up date until amputation were recorded.Results: A total of 19 feet of 19 patients (14 males, 5 females; mean age: 70.0±10.5 years; range, 53 to 91 years) in the control group and 18 feet of 18 patients (12 males, 6 females; mean age: 70.4±11.3 years; range, 54 to 91 years) were included. There was no statistically significant difference in amputation levels between the two groups (p=0.959). The mean time elapsed from the last diabetes control in the control and the pandemic group was 5.9±12.8 months and 8.2±9.8 months, respectively (p=0.038). A total of eight (42.1%) patients in the control group and seven (38.9%) patients in the pandemic group did not have a follow-up for diabetes in the last year prior to amputation (p=0.842). Conclusion:Although the COVID-19 pandemic seems to cause a delay in the routine medical care of patients with diabetes, it appears not to have an indirect effect on the lower extremity amputation level and incidence. Patients' adherence may be the major determinant in amputation surgery.

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

“…In Bangladesh, a retrospective single-center study [ 50 ] reported increased prevalence of total amputations as well as major and minor amputations during the pandemic period. In Turkey, a single single-center, retrospective study [ 51 ] reported that there was no change in the amputation incidence and levels during the pandemic period. In Israel, a retrospective study conducted at a level 2 medical center reported that there was no statistically significant difference in the mortality and major amputation rates in persons with diabetic ulcer before and during the pandemic [ 52 ].…”

“…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].…”

The Indirect Impact of COVID-19 Pandemic on Lower Extremity Amputations – An Australian Study

“…11,12 However, not all studies have found the same trend, with a few reporting no differences in amputation rates and two studies reporting a reduction in amputation rates during the pandemic. [12][13][14][15][16][17] The studies that reported a reduction in amputation procedures, however, reflect a shorter follow-up time of 3-4 months into the pandemic that only included the initial lockdown period of the pandemic and therefore fail to capture the intermediate to long-term effects of delayed procedures or follow-ups. 12,14 The state of Victoria had some of the strictest restrictions in Australia during the pandemic.…”

The effect of comorbid factors and amputation level on mortality in geriatric patients with diabetic foot

“…[ 1 ] Most of the patients with chronic illnesses did not have a regular follow-up during the pandemic due to individuals’ fear of getting the virus or self-isolation regulations. [ 2 ] Patients with DM have a lifetime risk of up to 25% of developing diabetic foot; however, approximately 60 to 80% of patients’ foot ulcers heal, while 10 to 15% do not progress and 5 to 24% eventually require a limb amputation. [ 3 ]…”

“…[1] Most of the patients with chronic illnesses did not have a regular follow-up during the pandemic due to individuals' fear of getting the virus or self-isolation regulations. [2] Patients with DM have a lifetime risk of up to 25% of developing diabetic foot; however, approximately 60 to 80% of patients' foot ulcers heal, while 10 to 15% do not progress and 5 to 24% eventually require a limb amputation. [3] Lower limb amputation (LLA) patients have a significant mortality rate, which may be due to the fact that the majority of patients are elderly and have many comorbid conditions in addition Objectives: The aim of this study was to evaluate the factors that influenced one-year and five-year mortality and to compare major and minor amputations in diabetic patients with comorbidities.Patients and methods: Between February 2008 and November 2014, a total of 201 type 2 diabetic foot patients (147 males, 54 females; median age: 65.99 years; range, 50 to 92 years) who underwent amputation were retrospectively analyzed.…”