Temporal Trends in Lower-Limb Major and Minor Amputation and Revascularization Procedures in People With Diabetes in England During the COVID-19 Pandemic
Jonathan Valabhji, Emma Barron, Eszter P. Vamos, Ketan Dhatariya, Frances L. Game, Partha Kar, Andy Weaver, Sophia Verma, Bob Young, Kamlesh Khunti
Abstract
The impact of the coronavirus disease 2019 (COVID-19) pandemic on amputation incidence in whole populations with diabetes is unknown. Previous reports are restricted to small cohorts from single specialist centers showing varying outcomes, including greater ulcer severity on presentation (1) and increased amputations (2). We aimed to carry out a population-based assessment of lower-limb major amputation, minor amputation, and revascularization procedure numbers and incidences during the first wave of the COVID-19 pandemic in England, covering the period March to June 2020, compared with equivalent time periods in 2017–2019. We also examined data 4 months following the first wave to assess if delayed presentations resulted in a rebound leading to higher than usual amputation incidence. The Secondary Uses Service data set contains data on inpatient care for all admissions to hospitals in England and was used to identify all major and minor lower-limb amputation and revascularization procedures in people with diabetes in England between 1 January 2017 and 31 October 2020, using all discharges from the hospital up to 31 December 2020. If more than one procedure was performed, all were counted for their respective analyses. For each year, the total number of people with diabetes aged 18 years and over was obtained from the National Diabetes Audit. Age, sex, ethnicity, and deprivation were identified as potential confounding factors. Due to geographical variations …