Influence of the COVID-19 pandemic on the amputation rate in Germany in patients with critical limb-threatening ischaemia

Objectives: The COVID-19 pandemic has shown a wide range of direct and indirect influences on the health of the population. This study examines the impact of the COVID-19 pandemic on the amputation rate in Germany in patients with critical limb-threatening ischaemia (CLTI). Methods: The epidemiological, pooled, and anonymised data of 476,168 CLTI patients from the Institute for the Hospital Remuneration System (InEK) were analysed for 2019-2023 at the federal level at weekly intervals and compared with epidemiological data for COVID-19 patients from the Robert Koch Institute (RKI) database, divided into the pandemic phases. Results: The number of inpatient cases declined by -4.64 % (p>0.05) from 2019 to 2020 and increased significantly by +7.07 % (p=0.001) from 2020 to 2023. The incidence of all lower limb amputations increased from 2019 to 2022 (23.9 vs. 25.7 %, p=0.01) with no significant changes in 2023. Moreover, the incidence of minor amputations increased from 16.9 % in 2019 to a maximum of 18.9 % (p<0.001) in 2022, and then to 18.4 % (p=0.02) in 2023. In the short-term perspective, inpatient cases significantly decreased in phases 1 and 3, with a relevant increase in the subsequent phases. However, the incidence of all amputations, especially minor ones, is constantly increasing. Conclusions: The COVID-19 pandemic has significantly indirectly impacted the management of CLTI patients, with a marked increase in the incidence of minor amputations, presumably due to the delayed presentation of patients with small necroses and due to limited access to healthcare.