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. 2021 Apr;2(4):216-226.
doi: 10.1302/2633-1462.24.BJO-2021-0008.R1.

The UK Foot and Ankle COVID-19 National (FAlCoN) audit

Jitendra Mangwani  1   2 , Karan Malhotra  3   4 , Linzy Houchen-Wolloff  5   6 , Lyndon Mason  7   8 ; UK FAICoN Audit Collaborative
Collaborators, Affiliations

The UK Foot and Ankle COVID-19 National (FAlCoN) audit

Jitendra Mangwani et al. Bone Jt Open. 2021 Apr.

Abstract

Aims: The primary objective was to determine the incidence of COVID-19 infection and 30-day mortality in patients undergoing foot and ankle surgery during the global pandemic. Secondary objectives were to determine if there was a change in infection and complication profile with changes introduced in practice.

Methods: This UK-based multicentre retrospective national audit studied foot and ankle patients who underwent surgery between 13 January and 31 July 2020, examining time periods pre-UK national lockdown, during lockdown (23 March to 11 May 2020), and post-lockdown. All adult patients undergoing foot and ankle surgery in an operating theatre during the study period were included. A total of 43 centres in England, Scotland, Wales, and Northern Ireland participated. Variables recorded included demographic data, surgical data, comorbidity data, COVID-19 and mortality rates, complications, and infection rates.

Results: A total of 6,644 patients were included. Of the operated patients, 0.52% (n = 35) contracted COVID-19. The overall all-cause 30-day mortality rate was 0.41%, however in patients who contracted COVID-19, the mortality rate was 25.71% (n = 9); this was significantly higher for patients undergoing diabetic foot surgery (75%, n = 3 deaths). Matching for age, American Society of Anesthesiologists (ASA) grade, and comorbidities, the odds ratio of mortality with COVID-19 infection was 11.71 (95% confidence interval 1.55 to 88.74; p = 0.017). There were no differences in surgical complications or infection rates prior to or after lockdown, and among patients with and without COVID-19 infection. After lockdown the COVID-19 infection rate was 0.15% and no patient died of COVID-19.

Conclusion: COVID-19 infection was rare in foot and ankle patients even at the peak of lockdown. However, there was a significant mortality rate in those who contracted COVID-19. Overall surgical complications and postoperative infection rates remained unchanged during the period of this audit. Patients and treating medical personnel should be aware of the risks to enable informed decisions. Cite this article: Bone Joint Open 2021;2(4):216-226.

Keywords: COVID-19; Complications; Foot and ankle surgery; Mortality; National audit; SARS-Cov-2.

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Conflict of interest statement

ICMJE COI statement: Data was collected by each participating NHS trust site and transferred securely to University Hospitals of Leicester NHS Trust (primary trust). The data collected locally on encrypted dated sheets was then uploaded to the Research Electronic Data Capture web application. All data was anonymised. Only anonymised data was transferred to the primary trust. All data complied with the requirements of the current legal framework in relation to data processing and with the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) as set out in the data processing agreement (uploaded separately). The study will be carried out in accordance with national and international guidelines, as well as the basic principles of the protection of the rights and dignity of Human Beings, as set out in the Helsinki Declaration (64th Assembly Fortaleza, Brazil, in October 2013), and according to current legislation.

Figures

Fig. 1
Fig. 1
Flow diagram displaying data cleansing of submitted data, with different levels of case exclusion.
Fig. 2
Fig. 2
Graphical representation of mortality rates for patients diagnosed with COVID-19, categorized into time periods and by case type.
Fig. 3
Fig. 3
Graphical representation of type of treatment received by patients with COVID-19 and the related complications they experienced.
See this image and copyright information in PMC

References

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