Outcomes of Acute Limb Ischemia at a Large Public Hospital in Brazil: Insights before, during and after the COVID-19 Pandemic

Abstract

Background

This study compared outcomes of patients with acute limb ischemia (ALI) before, during, and after the COVID-19 pandemic, hypothesizing that poor outcomes observed during the pandemic have not yet been resolved.

Methods

This retrospective, observational, single-center study analyzed ALI patients from 2019 to 2023.

Results

Over 5 years, 298 patients underwent surgery for ALI at our hospital: 35 had COVID-19 (COVID group), 132 tested negative (non-COVID group), 71 were treated before the pandemic (pre-COVID group), and 60 after (post-COVID group). In 2020, 32% of ALI patients had COVID-19, a percentage that decreased over time. Baseline characteristics shifted, influencing treatment. The pre-COVID group had more cardiac disease with embolic ALI and required mainly embolectomy; the COVID group had worse clinical conditions, undergoing embolectomy or amputation. The post-COVID group had more thrombotic ALI, with increased bypass surgery needs. Prolonged ischemia time was a concern during the entire study; 29% of patients presented with Rutherford III ischemia at admission, and 35.2% required major amputations. COVID group had higher mortality (48.6% vs. 15.5% pre-COVID, 22.7% non-COVID, and 28.3% post-COVID, P = 0.003). Additional factors contributing to mortality included older age (OR 1.05 CI: 1.02–1.08, P < 0.001), prior stroke (OR 2.38, CI: 1.07–5.38, P < 0.001), chronic obstructive pulmonary disease (COPD) (OR 1.88, CI: 0.53–6.59, P = 0.03), and aorto-iliac ALI (OR 8.72, CI: 1.25–22.63, P < 0.01).

Conclusion

Delayed presentations of ALI patients persisted before, during, and after the pandemic, resulting in many cases of irreversible ischemia at admission and increased amputation rates. Mortality rates correlated with COVID-19, older age, COPD, prior stroke, and aorto-iliac involvement.