By Jennifer Spector, DPM, FACFAS, Associate Editor
In a recently published study in the Annals of Vascular Surgery, researchers found a more than twofold increase in major amputations and the degree of tissue loss for vascular surgery patients after the arrival of the COVID-19 pandemic in 2020 in comparison to patients in similar time frames in 2019 and 2018.
For the study, researchers analyzed data on a total of 38 patients who underwent 46 vascular surgery procedures during a six-week period in March and April of 2020. They found a significant increase in the number of major amputations (42 percent in 2020 in comparison to 18 and 15 percent in 2019 and 2018 respectively). They also noted a significantly higher degree of tissue loss (90 percent Rutherford grade V and VI in comparison to 41 and 48 percent in 2019 and 2018 respectively).
Also, a recent study in Diabetes Care revealed a more than threefold risk of amputation in 25 patients with DFUs admitted to a tertiary care center between March 9 and May 18, 2020 in comparison to 38 patients admitted to the center in the first five months of 2019.
Erin E. Klein, DPM, FACFAS, DABPM, says amputations have increased in her practice since March and specifically notes the number of transmetatarsal amputations in these last several months in her practice already exceeds the total number from all of last year. Dr. Klein has also received significantly more calls from the ER about emergent cases.
“Many offices closed and left patients without care. These patients ignore things for too long and then head to the ER with a severe systemic infection,” notes Dr. Klein.
Adam L. Isaac, DPM, FACFAS says the study findings are predictable but adds that the current situation is reflective of a wave of patients returning for missed care through no fault of their own. He says this includes patients who simply needed periodic foot examinations or nail and callus care, and wound up developing ingrown nails or blisters that became ulcers. While these cases do not equate to major amputation, it is important to point out that there are other implications such as increased antibiotic usage and lost wages for these patients, says Dr. Isaac, the Director of Research with Foot and Ankle Specialists of the Mid-Atlantic (FASMA).
“The increase in amputations is just another indirect effect of COVID-19 on health-care systems around the world,” says Lee C. Rogers, DPM, DABPM. “The pandemic interrupted care for chronic conditions but also led to a reduced willingness for patients to seek out care for emergencies. Thus, the effect on increasing amputations is not surprising.”
Dr. Isaac relates being able to keep his offices open for urgent and emergent visits during the period of peak cases in his area. His practice’s Amputation Prevention Center is a “wound center without walls” that can provide advanced wound care in an office setting without patients having to go to a hospital for some of these services.
“Many patients did express a higher level of comfort in seeking care in an office setting and as a result, we lost very few to follow up,” says Dr. Isaac. “Several regional tertiary care centers actually referred patients to us as they prepared for an influx of COVID-19 patients.”
Patients have interestingly shown even higher levels of adherence to her treatment recommendations since the pandemic arrived in the United States, says Dr. Klein, a fellowship-trained foot and ankle surgeon.
Practice pattern changes for podiatrists as a result of the COVID-19 pandemic will be long-term, notes Dr. Rogers, a member of the Board of Directors for the American Board of Podiatric Medicine.
“Podiatrists should be prepared for permanent changes. I do predict that physician offices, hospitals and other health-care settings will see lasting changes in cleanliness, masks in clinical areas, distancing in waiting rooms, the use of telemedicine and other technologies like remote patient monitoring,” explains Dr. Rogers.