The UK Foot and Ankle COVID-19 National (FALCON) Audit – rate of COVID-19 infection and 30 day mortality in foot and ankle surgery in the UK

L. Houchen-Wolloff, K. Malhotra, J. Mangwani, L. Mason

¹University Hospitals of Leicester NHS Trust, Trauma and Orthopaedics, Leicester, United Kingdom

²Royal National Orthopaedic Hospital NHS Trust, Trauma and Orthopaedics, Stanmore, United Kingdom

³Leicester NHS Trust, Trauma and Orthopaedics, Leicester, United Kingdom

⁴Liverpool university Hospital NHS Foundation Trust, Trauma and Orthopaedics, L9 7AL, United Kingdom

 

Winner of the BOFAS 2021 Best Free Paper Prize (Chang Chen Memorial Prize)

Objectives: 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.

Design: Multicentre retrospective national audit.

Setting: UK-based study on foot and ankle patients who underwent surgery between the 13^th January to 31^st July 2020 – examining time periods pre- UK national lockdown, during lockdown (23^rd March to 11^th May 2020) and post-lockdown.

Participants: All adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 43 participating centres in England, Scotland, Wales and Northern Ireland.

Main Outcome Measures: Variables recorded included demographics, surgical data, comorbidity data, COVID-19 and mortality rates, complications, and infection rates.

Results: 6644 patients were included. In total 0.52% of operated patients contracted COVID-19 (n=35). 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, ASA and comorbidities, the OR of mortality with COVID-19 infection was 11.71 (95% CI 1.55 to 88.74, p=0.017). There were no differences in surgical complications or infection rates prior to or after lockdown, and amongst patients with and without COVID-19 infection. After lockdown COVID-19 infection rate was 0.15% and no patient died of COVID-19 infection.

Conclusions: 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 post-operative 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.

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