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A cross-sectional study evaluating hospitalization rates for chronic limb-threatening ischemia during the COVID-19

Eugenio Stabile1, Raffaele Piccolo1, Michele Franzese1

  • 1Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy.

Vascular Medicine (London, England)
|December 17, 2020
PubMed

Insights

The COVID-19 lockdown in Italy reduced hospitalizations for chronic limb-threatening ischemia (CLTI) but significantly increased amputation rates. Prioritizing CLTI patient care during pandemics is crucial.

Area of Science:

  • Vascular Surgery
  • Public Health
  • Epidemiology

Background:

  • The COVID-19 pandemic necessitated government-imposed containment measures, including national lockdowns.
  • These measures impacted healthcare access and delivery for various medical conditions.
  • Chronic limb-threatening ischemia (CLTI) requires timely intervention to prevent severe outcomes.

Purpose of the Study:

  • To assess the impact of the COVID-19 lockdown on CLTI patient hospitalization rates.
  • To evaluate changes in in-hospital treatment modalities for CLTI during the lockdown period.
  • To compare CLTI management before and during the national lockdown in Italy's Campania region.

Main Methods:

  • Retrospective analysis of 453 CLTI patients hospitalized in Campania over a 10-week period (5 weeks pre-lockdown, 5 weeks during lockdown).
  • Data collected on hospitalization rates, medical treatment, revascularization procedures, and major amputations.
  • Incidence rate ratios (IRR) and p-values were calculated to compare pre-lockdown and lockdown periods.

Main Results:

  • A significant reduction in CLTI hospitalizations was observed during lockdown (IRR: 0.34; 95% CI 0.32-0.37).
  • The rate of in-hospital major amputations increased substantially during lockdown (29.3% vs 13.4%; p < 0.001).
  • Revascularization was performed in 78.1% of patients, and 21.9% received medical treatment.

Conclusions:

  • The COVID-19 lockdown in Campania led to decreased CLTI hospitalizations but a higher rate of amputations.
  • This highlights potential delays in care or presentation of more severe CLTI cases during the lockdown.
  • Maintaining essential services for CLTI patients is imperative during public health crises.

Keywords:
COVID-19chronic limb-threatening ischemia (CLTI)peripheral artery disease (PAD)

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