{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T16:27:51Z","timestamp":1766507271514,"version":"3.48.0"},"reference-count":18,"publisher":"Walter de Gruyter GmbH","issue":"4","license":[{"start":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T00:00:00Z","timestamp":1734480000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_iss-2024-0035_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The COVID-19 pandemic has shown a wide range of direct and indirect influences on the health of the population. This study examines the impact of the COVID-19 pandemic on the amputation rate in Germany in patients with critical limb-threatening ischaemia (CLTI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_iss-2024-0035_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The epidemiological, pooled, and anonymised data of 476,168 CLTI patients from the Institute for the Hospital Remuneration System (InEK) were analysed for 2019\u20132023 at the federal level at weekly intervals and compared with epidemiological data for COVID-19 patients from the Robert Koch Institute (RKI) database, divided into the pandemic phases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_iss-2024-0035_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The number of inpatient cases declined by\u00a0\u22124.64\u202f% (p&gt;0.05) from 2019 to 2020 and increased significantly by +7.07\u202f% (p=0.001) from 2020 to 2023. The incidence of all lower limb amputations increased from 2019 to 2022 (23.9 vs. 25.7\u202f%, p=0.01) with no significant changes in 2023. Moreover, the incidence of minor amputations increased from 16.9\u202f% in 2019 to a maximum of 18.9\u202f% (p&lt;0.001) in 2022, and then to 18.4\u202f% (p=0.02) in 2023. In the short-term perspective, inpatient cases significantly decreased in phases 1 and 3, with a relevant increase in the subsequent phases. However, the incidence of all amputations, especially minor ones, is constantly increasing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_iss-2024-0035_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The COVID-19 pandemic has significantly indirectly impacted the management of CLTI patients, with a marked increase in the incidence of minor amputations, presumably due to the delayed presentation of patients with small necroses and due to limited access to healthcare.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/iss-2024-0035","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T04:32:53Z","timestamp":1734409973000},"page":"211-220","source":"Crossref","is-referenced-by-count":0,"title":["Influence of the COVID-19 pandemic on the amputation rate in Germany in patients with critical limb-threatening ischaemia"],"prefix":"10.1515","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4845-4728","authenticated-orcid":false,"given":"Wojciech","family":"Derwich","sequence":"first","affiliation":[{"name":"Vascular and Endovascular Surgery of Department of Cardiac and Vascular Surgery , University Hospital Frankfurt Goethe University , Frankfurt\/Main , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Sch\u00f6ffski","sequence":"additional","affiliation":[{"name":"School of Business and Economics, Chair of HealthCare Management , Friedrich-Alexander-University of Erlangen-N\u00fcrnberg , N\u00fcrnberg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Institute for Biostatistics and Mathematical Modeling, Goethe University Frankfurt , Frankfurt\/Main , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyriakos","family":"Oikonomou","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery of Department of Cardiac and Vascular Surgery , University Hospital Frankfurt Goethe University , Frankfurt\/Main , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"2025122314030566746_j_iss-2024-0035_ref_001","doi-asserted-by":"crossref","unstructured":"Msemburi, W, Karlinsky, A, Knutson, V, Aleshin-Guendel, S, Chatterji, S, Wakefield, J. 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