Impact of COVID-19 Pandemic on the outcomes in patients with Critical Limb Threatening Ischaemia and Diabetic Foot Infection.

Musajee, Mustafa; Zayed, Hany; Thulasidasan, Narayanan; Sayed, Mohamed; Francia, Federica; Green, Meryl; Arissol, Martin; Lakhani, Alpa; Biasi, Lukla; Patel, Sanjay

OBJECTIVE Examine the impact of Coronavirus-2019(COVID-19) pandemic on the outcomes in patients with critical limb threatening ischemia(CLTI) or diabetic foot infection(DFI). BACKGROUND Patients with CLTI and/or DFI are at risk of amputations if not treated in a timely manner. METHODS We compared the outcomes in patients with CLTI or DFI during two periods; Period 1[P1] (15/03/2019-31/05/2019) and period 2[P2] (15/03/2020-31/05/2020- corresponding to COVID-19 pandemic). RESULTS 139 patients were treated in P1 [mean age 70 years (±11), Male:Female=102:37] while 95 patients were treated in P2 [mean age 67(±12), Male:Female=64:31]. The two cohorts were matched regarding Rutherford category (P=0.25) and GLASS classification (P=0.38). Notably, the time from onset of symptom to clinical presentation was significantly longer [31(1-105) days vs 27(0-78) days, (P=0.017)], whereas the time from presentation to first intervention was significantly shorter [3 (0-61) days vs 5 (0-65) days, (P=0.013)] in P2 compared to P1. There was a significantly higher WCC(P=0.014) and CRP(P=0.004) on admission in P2. Having treatment for CLTI or DFI in P2 was an independent predictor of worse primary patency rate and Freedom from major adverse limb events (F-MALE). At 90 days, amputation-free survival (AFS) and Limb salvage (LS) were noticeably worse in P2 compared to P1 (AFS was 80% and 87% while LS was 64% and 72% in P2 and P1 respectively). CONCLUSIONS Patients with CLTI and DFI experienced a significantly delayed presentation with features of sepsis on admission in P2. Treatment in P2 was a predictor of worse primary patency and F-MALE and therefore close and long follow-up is advisable.