Covid-19 pandemic lockdown : Uncovering the hard truth on lower limb ischaemic outcomes? A single centre observational study

Abstract

The COVID-19 pandemic disrupted hospital services worldwide and Malta was no exception. This was especially true for vascular surgery where societies issued recommendations on how to adjust their services during the first wave of the pandemic. Malta has one tertiary hospital, with a vascular unit that was established in 2007. Since then, all lower limb procedures have been registered in the Maltese vascular registry (MaltaVasc), which has been internationally validated. In Malta, COVID-positive patient zero was recorded on 7 March 2020. The closure of the only airport was carried out on 21 March and a partial intelligence lockdown was started on 27 March, whereby vulnerable patients were advised to stay home and avoid going to work. On 5 June 2020, the government of Malta and Public Health authorities eased the lockdown for vulnerable patients and on 1 July 2020 the airport was opened to 19 destinations, with a gradual opening to other countries. Despite the partial lockdown, patients with hospital appointments were advised to keep their appointments unless they were cancelled by medical staff. Elective lists were reduced and non-urgent surgeries postponed. During this time, it was noted that few patients were presenting to hospital with signs and symptoms of chronic limb threatening ischaemia (CLTI). Furthermore, it was felt that patients with CLTI were presenting to hospital late, requiring either palliation or major amputation, and more patients required major amputation than in previous years. The primary aim of this study was to analyse the number of major and minor amputations, elective and/or urgent and emergency revascularisation procedures during the first wave of the COVID-19 pandemic. The secondary aims were to compare the number of lower limb procedures with the previous year and also to compare the rates of major amputations with the prevascular unit time period where few lower limb revascularisations were carried by the same authors.