E-Poster Presentation ESA-SRB-ANZBMS 2021

Lower limb amputations in patients with diabetes-related foot complications in the COVID-19 pandemic (#372)

Lucy Collins 1 , Jane Jolley 2 , Rahul D Barmanray 1 3 , Catherine Seymour 1 , Spiros Fourlanos 1 3 , Paul Wraight 1
  1. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  2. Department of Allied Health, Royal Melbourne Hospital, Parkville, VIC, Australia
  3. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia

The COVID-19 pandemic caused disruption to healthcare with concern about individuals delaying or avoiding presentation. In-person reviews have been limited with a major shift towards Telehealth. This has raised concern for the management of diabetes-related foot complications, which has traditionally required in-person visits for debridement, dressings and offloading (1). Delay in access to care can lead to significant mortality, morbidity and loss of limbs (2). Melbourne’s first case of COVID-19 was detected in January 2020 and in March 2020 elective surgery was suspended.

 

Aim

To examine the effect of the COVID-19 pandemic on the rates of lower limb amputations in individuals with diabetes-related foot complications.

 

Method

This retrospective audit of medical records analysed rates of amputations at a large hospital in Victoria, Australia. Comparisons were made between pre-COVID-19 (January-December 2019) and post-COVID-19 (January-December 2020) onset periods. Descriptive statistical analyses were utilised.

 

Results

In 2019, 84 lower limb amputations were performed in individuals with diabetes-related foot complications at the Royal Melbourne Hospital (RMH). Of those, 56 occurred in individuals directly admitted under the Diabetic Foot Unit (DFU). In 2020, 96 amputations occurred, 61 in individuals admitted under the DFU. The percentage of individuals admitted under the DFU requiring an amputation was 48% in 2019 and 58% in 2020. Ulcer duration was similar in 2019 and 2020 despite the lockdown and COVID-19 related restrictions. Comparing 2019 and 2020, rates of osteomyelitis were 52% vs. 65%, gangrene 56% vs. 60% and cellulitis 73% vs. 80% (Table 1).

 

Conclusion

Following the onset of the COVID-19 pandemic, a greater proportion of individuals presented with osteomyelitis, gangrene and cellulitis associated with foot ulcers, which may have contributed to the greater number of amputations performed in 2020. As RMH prioritised in-person reviews during the COVID-19 pandemic, the effect of a shift to virtual healthcare is unknown.

 

611f5e73374e5-Screen+Shot+2021-08-20+at+5.41.08+pm.png

  1. Shin, L., Bowling, F., Armstrong, D. and Boulton, A., 2020. Saving the Diabetic Foot During the COVID-19 Pandemic: A Tale of Two Cities. Diabetes Care, 43(8), pp.1704-1709.
  2. Caruso, P., Longo, M., Signoriello, S., Gicchino, M., Maiorino, M., Bellastella, G., Chiodini, P., Giugliano, D. and Esposito, K., 2020. Diabetic Foot Problems During the COVID-19 Pandemic in a Tertiary Care Center: The Emergency Among the Emergencies. Diabetes Care, 43(10), pp.e123-e124.