Increasing Need For Guillotine Amputations During The COVID-19 Era
Judson Chase Woollen, MD, John Neill, MD, Mark P. Androes, MD, Joseph Blas, MD, Sagar Gandhi, MD, Christopher G. Carsten, III, MD.
PRISMA Health Upstate, Greenville, SC, USA.
OBJECTIVES: Guillotine amputations (GA’s) are employed in patients with advanced infection of the foot and are most commonly utilized in diabetic patients. As a result of the COVID-19 pandemic there has been both a decrease in utilization of health care resources as well as barriers to receiving routine health maintenance. We have noticed an increase in the need for GA’s in patients presenting to our hospital with diabetic foot infections. The purpose of this study is to compare patients requiring GA during the COVID-19 pandemic to those during the same time period the year prior to COVID-19.
METHODS: We retrospectively reviewed the medical records of all patients requiring GA during the time period of 3/1/2020 until 7/30/20 and compared them to the cohort of patients requiring GA during the same period during 2019. Demographic data, presenting lab data, COVID status were recorded. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was calculated for each group. The 30 day return to the OR, need for above knee amputation, and mortality were noted.
RESULTS: There were 19 patients presenting during the COVID-19 pandemic who required GA compared to 13 patients who presented during the same months the year before. All patients were diabetic. There were no statistically significant differences in the patient demographics. One patient in the 2020 group was COVID-19 positive. Patients in the 2020 cohort presented with higher leukocytosis levels (16.77±7.77 vs 22.22±6.67 p=0.05) and worse LRINEC scores (7.27±2.97 vs 9.57±2.07 p=0.04). Although they did not reach statistical significance, 3 patients died in the 2020 group while none died in the 2019 group and 2 required a return to the OR within 30 days in the 2020 group vs none in the 2019 group.
CONCLUSIONS: During the COVID-19 pandemic our hospital witnessed a 46% increase in the need for GA in our diabetic patients with foot wounds. Patients presented with higher leukocytosis and lab values predictive of necrotizing fasciitis. Further studies are needed to determine if lack of access to care contributed to the increase.
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