A cross-sectional study evaluating hospitalization rates for chronic limb-threatening ischemia during the COVID-19 outbreak in Campania, Italy

Stabile, Eugenio; Piccolo, Raffaele; Franzese, Michele; Accarino, Giancarlo; Bracale, Umberto Marcello; Cappello, Enrico; Cioffi, Giovanni; Cioppa, Angelo; Crinisio, Adolfo; Flora, Loris; Landino, Pietro; Martelli, Eugenio; Mancusi, Rosario; Niola, Raffaella; Petrosino, Fernando; Razzano, Davide; Ruotolo, Carlo; Salemme, Luigi; Sangiuolo, Paolo; Santini, Gianpaolo; Soreca, Emilio; Vigliotti, Gennaro; Villari, Bruno; Amabile, Giampaolo; Ammollo, Raffaele Pio; Barbarisi, Danilo; Corbisiero, Alfonsina M; D’angelo, Antonio; Cangiano, Gianluca; De Gregorio, Claudia; De Laurentis, Mario; Laurenzano, Eugenio; Ficarelli, Ilaria; Luongo, Alessandro; Molino, Claudio; Sarti, Giuseppe; Viola, Daniela; Esposito, Giovanni

The expansion of coronavirus disease 2019 (COVID-19) prompted measures of disease containment by the Italian government with a national lockdown on March 9, 2020. The purpose of this study is to evaluate the rate of hospitalization and mode of in-hospital treatment of patients with chronic limb-threatening ischemia (CLTI) before and during lockdown in the Campania region of Italy. The study population includes all patients with CLTI hospitalized in Campania over a 10-week period: 5 weeks before and 5 weeks during lockdown (n = 453). Patients were treated medically and/or underwent urgent revascularization and/or major amputation of the lower extremities. Mean age was 69.2 ± 10.6 years and 27.6% of the patients were women. During hospitalization, 21.9% of patients were treated medically, 78.1% underwent revascularization, and 17.4% required amputations. In the weeks during the lockdown, a reduced rate of hospitalization for CLTI was observed compared with the weeks before lockdown (25 vs 74/100,000 inhabitants/year; incidence rate ratio: 0.34, 95% CI 0.32–0.37). This effect persisted to the end of the study period. An increased amputation rate in the weeks during lockdown was observed (29.3% vs 13.4%; p < 0.001). This study reports a reduced rate of CLTI-related hospitalization and an increased in-hospital amputation rate during lockdown in Campania. Ensuring appropriate treatment for patients with CLTI should be prioritized, even during disease containment measures due to the COVID-19 pandemic or other similar conditions.