July 02, 2020
Due to high rates of COVID-19 risk factors in US veterans with critical limb ischemia, management of patients with lower extremity amputations should include careful COVID-19 transmission precautions, expedient discharge after amputation, and telehealth appointments when possible, according to a study in the journal Military Medicine.
“In a retrospective cohort study using nationwide data from a Veterans Affairs Surgical Quality Improvement database, a significant proportion of veterans requiring nontraumatic lower extremity amputations were found to have one or more comorbidities that have been definitively associated with elevated rates of COVID-19 hospitalization and case fatality,” reported researchers from Virginia Commonwealth University School of Medicine and Central Virginia Veterans Affairs Health Care System.
Specifically, the study found 88.7% of veterans who received below-knee amputations and 82.4% of veterans who received above-knee amputations between 1999 and 2018 had at least one risk factor currently linked with increased COVID-19 hospitalization and case fatality. Veterans with below-knee amputations who were African American were significantly more likely than those who were not African American to present with at least one risk factor for COVID-19 hospitalization and fatality.
Advanced age, common in the population, also puts patients at especially high risk if they contract the virus, researchers noted.
“Until the pandemic is abated, telehealth should be utilized for routine follow-ups following amputation, and postoperative care should include screening for upper respiratory symptoms,” they advised. “Expedient postamputation discharge is recommended to protect these patients.”
Dittman JM, Tse W, Amendola MF. Optimizing Peripandemic Care for Veteran Major Non-Traumatic Lower Extremity Amputees: A Proposal Informed by a National Retrospective Descriptive Analysis of COVID-19 Risk Factor Prevalence [published online ahead of print, 2020 Jun 30]. Mil Med. 2020;usaa180. doi:10.1093/milmed/usaa180