Covid-19, a cut above the rest. Retrospective analysis of amputation levels pre- and post-Covid-19

Name: Catherine Finlayson

E-mail: catherine.finlayson1@nhs.net

Occupation: Clinical Lead Prosthetist / National Operations Manager, CPO

Affiliation: Opcare, UK

Other authors: None

 

ABSTRACT

Covid-19 has had an unprecedented effect on the NHS. Evidence shows that the number of GP appointments attended in the early stages of the Covid-19 pandemic (March/April 2020) fell significantly [1]. There has been a significant increase in waiting times to see GPs and for subsequent referral to consultant-led services.

The wider impact on public health and the consequences for surgical departments and outpatient rehabilitation clinics is uncertain. With a lack of face-to-face outpatient appointments (GPs, nurses, podiatrists etc.) available/permitted, it is perceived that patients presented to medical departments with more advanced disease leading to more invasive treatments such as major amputation, rather than limb salvage surgery.

Additionally, the perception is that the reasonably accepted ratio of trans-tibial amputations versus trans-femoral amputations of 5:3 changed due to more trans-femoral amputations being required following the series of Covid-19 lockdowns and closure of face-to-face outpatient clinics. Furthermore, longer waits to begin rehabilitation will likely have had a detrimental impact on overall patient outcome.

Compared to pre-Covid-19 levels in 2019, there was an increased proportion of above-knee referrals received in the Exeter prosthetic service in 2020 and 2021, with 8% and 7% increases respectively. In terms of the number of above-knee amputee patients referred on for prosthetic limb wearing and rehabilitation there was a 36% increase from 2019 to 2021, and a 138% increase from 2020 to 2021. Additionally, there was a 7% and 8% decrease in pre-amputation referrals received in 2021 compared to 2019 and 2020 respectively, indicating a shift in patient management style and suggests that patients have been presenting with more advanced disease following the onset of Covid-19. Besides the increased costs of the limbs themselves, the overall cost of above knee amputation is greater due to more expensive initial rehabilitation devices and physiotherapy, more prosthetist time in fitting, and more workshop time in manufacture.

This study has shown an increased proportion of above-knee amputee patients being referred in Exeter compared to previous years. It is likely, given the trends in referrals being received following national and local lockdowns, that this was a consequence of Covid-19 related delays. Understanding this trend is vital for service planning. Preliminary results indicate that a similar trend is occurring nationwide, with approximately 78% of prosthetic services examined being found to show higher proportions of above-knee referrals being received.

References

[1] Charlesworth, Anita. Shock to the system: COVID-19’s long-term impact on the NHS. May 28, 2020.https://www.health.org.uk/news-and-comment/blogs/shock-to-the-system-covid-19s-long-term-impact-on-the-nhs (accessed August 7, 2022).