More leg amputations due to lockdown in care

Vascular surgeon Lijckle van der Laan started to notice it in April: he and his colleagues at the Amphia Hospital in Breda had to perform more and more large amputations. Removing a leg instead of a toe. These were elderly people with, for example, arteriosclerosis.

They had wounds to the foot, gangrene or a sore, sometimes already black toe. “They did not dare to go to the doctor, they came too late to the hospital,” says Van der Laan. With all the consequences that entails

The cessation of regular care due to the corona crisis has led to an increase in the number of large amputations in more hospitals, according to a tour of the CCeit along 17 hospitals. This was particularly the case in Noord-Brabant and Limburg.

The Amphia Hospital is the only one that kept records. Between March and the end of April, Van der Laan and the vascular team saw 19 patients with problems on their feet. In other years 15 percent of the interventions were amputations of a large part of the leg; now 42 percent.

The results of Van der Laan’s research will soon be published in the scientific journal Annals of Vascular Surgery, but are already online.

Angst to ask for care

“One of the most important reasons is the fear that has been created to ask for care”, says Van der Laan. Patients did not dare to go to the doctor, they said. They were often not allowed to visit. General practitioners did as many consultations as possible by telephone. “But you really have to see these patients to determine how serious the wound is.”

In the case of the patients with an amputated leg, such a check did not come in time. “If you’re late, the dead tissue pulls from the toe to the forefoot. At some point, you won’t be able to make it. Then you have to amputate a large part of the leg.”

In many hospitals, regular care was completely flat due to corona care. Hospitals kept non-corona-patients out of care at the beginning of the crisis. The risk of infection and the lack of protective equipment also played a role

“That really has to change with a possible second wave”, says Van der Laan. “Doctors have to keep seeing patients.” The Dutch Health Care Authority agrees. Since the start of the corona outbreak in the Netherlands 800,000 less people have gone to their GPs.

“Some patients had complaints that were neither urgent nor spontaneous,” says NZa chairman Marian Kaljouw. “But there was also a group in whom it led to health damage, such as the patients in whom even amputation was necessary. If they had gone to the doctor in March, it wouldn’t have been as bad as it is now.”