Objectives
It is well-described that coronavirus disease 2019 (COVID-19) can lead to a prothrombotic state; however, the implications this has on major amputations is unclear. Previous single center studies have described an increase in acute limb ischemia and amputation rates in patients with COVID; however, this hypothesis has yet to be confirmed in a larger sample size. We aim to investigate rates of major amputation during the COIVD-19 pandemic.
Methods
Using the National Inpatient Sample database, we used International Classification of Diseases, 10th edition, codes to identify all patients within the database who underwent major limb amputations during the year 2018 and 2020 to calculate overall amputation rates. We chose 2020 as the first full year of the COVID-19 pandemic and 2018 was chosen as a comparison year. Additionally, we compared a random sampling of patients hospitalized during 2018 to a random sampling of patients with COVID during 2020. Statistical analyses were conducted to compare the rate of major amputations, comorbidities, and complication rates between the two.
Results
Overall, in 2018, 0.3% of all hospitalized patients represented in the database underwent major amputations, which was not significantly different compared to the 0.4% of all hospitalized patients in 2020 (Table). Additional analysis within our random samplings, COVID-positive patients had an amputation rate of 2.30% which was significantly less than a random sampling of patients without COVID in 2018 at 3.66% (P < .001). In patients who underwent amputations, those who also had COVID were less likely to be smokers, and less likely to have coronary artery disease and HLD (all P < .05). When controlling for comorbidities, there was no change in cardiac, stroke, bleeding, or vascular complications between the two groups. There was a significantly higher risk for respiratory complications in the COVID-positive group.
Conclusions
Despite smaller studies indicating an increased risk for major amputation in COVID-positive patients, analysis of a large database of hospitalized patients show no increased rate of amputations during the first year of the COVID pandemic and no increased risk of amputation in hospitalized patients with COVID. However, COVID patients who required major amputation had fewer comorbidities than non-COVID patients indicating a possible increase risk of amputation in healthier patients if afflicted with COVID.
Table.
Characteristics and postoperative outcomes for patients who underwent major amputations stratified by coronavirus disease 2019 (COVID) status
| No COVID (673) | COVID (n = 135) | P value | |
|---|---|---|---|
| Demographics and comorbidities | |||
| Age >65 | 364 (54.1) | 64 (47.4) | .1559 |
| Sex (male) | 203 (30.2) | 45 (33.4) | .4661 |
| Hypertension | 575 (85.44) | 106 (78.5) | .0438 |
| Diabetes | 418 (62.1) | 84 (62.2) | .98 |
| Smoking | 331 (49.2) | 41 (30.4) | <.001 |
| Chronic kidney disease | 274 (40.7) | 52 (38.5) | .6352 |
| Chronic obstructive pulmonary disease | 144 (21.4) | 30 (22.2) | .8314 |
| Congestive heart failure | 194 (28.8) | 46 (34.1) | .2233 |
| Coronary artery disease | 296 (43.98) | 45 (33.3) | .0222 |
| Hyperlipidemia | 356 (52.9) | 56 (41.5) | .0155 |
| Complications | |||
| Cardiac | 35 (5.2) | 10 (7.41) | .3075 |
| Respiratory | 60 (8.9) | 41 (30.4) | <.001 |
| Bleeding | 7 (1.04) | 0 | |
| Postoperative stroke | 5 (0.74) | 1 (0.74) | .9978 |
| Vascular | 1 (0.15) | 1 (0.74) | .2064 |
Values are number (%).
PC124
Footnotes
Author Disclosures: K. I. Alnahhal: Nothing to disclose; S. Kumar: Nothing to disclose; J. Lee: Nothing to disclose; P. Salehi: Nothing to disclose; O. Selim: Nothing to disclose; A. Tedesco: Nothing to disclose.