Outcomes of Patients Admitted With COVID-19 Requiring Lower Extremity Interventions

Abstract

The incidence and outcomes of patients with associated acute lower extremity ischemia (ALI) admitted with COVID-19 undergoing intervention is not clearly defined in the real-world population. Patients admitted with COVID-19 undergoing lower extremity (LE) procedures (open [OPEN] and endovascular [ENDO]) were evaluated regarding procedure types, demographics, and COVID-19 disease severity and outcomes. A retrospective study of a COVID-19 cohort in the Cerner Real-World Data, was queried from December 2019 to 2021. Included were LE procedures during inpatient COVID admission, disease severity using International Classification of Diseases, Tenth Edition (ICD-10) disease and procedure codes (admitted with COVID, COVID pneumonia [COVID-PNA], and severe COVID requiring mechanical ventilation [COVID-SD]), and outcomes including amputation and mortality. A total of 1,877,151 patients admitted with COVID were evaluated (1,342,708 admitted with COVID, 416,900 with COVID-PNA, and 117,543 with COVID-SD). Average age was 51.8 years, with men (45.0%), women (55.0%), Whites (70.0%), and Blacks (11.7%). Stratified by COVID severity, the incidence of COVID patients requiring LE procedures was 0.68% for COVID, 0.52% for COVID-PNA, and greater for COVID-SD 1.44% (P < .0001). A total of 6986 OPEN and 6032 ENDO LE procedures were performed (53.7% vs 46.3%; P < .0001). Overall mortality was 13.8% ENDO vs 11.5% OPEN (P < .05). Of those undergoing procedures, 61.4% were men vs 38.6% women (P < .0001). Following LE procedures, overall amputations occurred in 15.8% with no difference between OPEN and ENDO procedures (16.1% vs 15.4%; P = .3) or gender (men 16% vs women 15.3%; P = .3), but race was significantly different (Black 22.7% vs White 14.1%; P < .0001). Amputation rates significantly increased by COVID severity for ENDO (COVID 14.17% vs 20.5% COVID-SD; P < .0001) and OPEN (COVID 13.80% vs COVID-SD 23.01%; P < .0001). Overall mortality significantly increased for patients with COVID-SD (P < .0001). Although thrombotic events are increased with COVID, the number of patients requiring an LE intervention after hospitalization with COVID is low. Patients more often underwent OPEN procedures and were men. OPEN and ENDO procedures had similar amputation rates but were significantly higher for Black patients. Increased COVID severity was associated with significantly higher numbers of LE procedures performed, mortality rates, and amputations. Interestingly, gender did not influence outcomes following LE procedures in patients with COVID. These data may influence development of algorithms for treatment of COVID-associated ALI favoring endovascular therapies over open surgery and consideration of primary amputation over revascularization in patients with severe COVID.