UK Foot and Ankle COVID-19 National Audit (UK-FALCON)

COVID-19 has had a profound effect on healthcare systems in the UK is. On 23rd March 2020, the UK announced a national lockdown and surgical governing bodies issued guidance to temporarily halt elective activity to enable staffing and resources to be redeployed to trauma and emergency care. However, the incidence of COVID-19 in the population undergoing surgery was not examined.

There was therefore an urgent need to understand the incidence and impact of perioperative symptomatic COVID-19 in patients who had undergone foot and ankle surgery to estimate the possible risk going forward and to plan interventions to limit this risk. Such data could also be used to inform management and planning for subsequent waves of the disease.

 

Scope

To this end the UK-FALCON Audit was set up with the primary objective 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. Further outcomes included examination of regional variations in activity and COVID-19 infection rate.

 

Design

This was a multicentre retrospective national audit with data submitted on over 7,000 patients undergoing foot and ankle sugery from 43 units across the country. Data was analysed for the first UK national lockdown period and 10 weeks either side of this (from January 2020 to July 2020). This constitutes Phase 1. Phase 2 was performed using the same methodology and included the period of recovery post-lockdown and the second national lockdown (from September 2020 to November 2020). 

 

Results

The final report incorporating the results from both Phase 1 and 2 can be accessed here.

 

Acknowledgements

We would like to extend our gratitude to all the members who participated in this important, first of its kind, national foot and ankle project – without your efforts this would not have been possible.

We would also like to acknowledge University of Leicester Hospitals Charity for funding the project, and NIHR Leicester Biomedical Research Centre for managing the data. 

 

 


 

UK Foot and Ankle Thromboembolism (UK FATE) Collaborative

The last BOFAS VTE position statement was published by BOFAS Scientific Committee in September 2017. NICE guidance on VTE prophylaxis for hip and knee arthroplasty has been amended since and helped units in the country to achieve a uniform approach in the management of this controversial clinical problem. There is wide variation in the threshold and provision of thromboprophylaxis in the treatment of foot and ankle conditions and units may have varying protocols. One of the difficulties in affecting change in practice in this area is the low incidence of postoperative, symptomatic VTE. Therefore, a large number of patients need to be included in any series for meaningful conclusions to be drawn.

 

Scope

The UK-FATE Audit was approved by the BOFAS Outcomes and Scientific Committees in March 2022, on the back of the success of the UK-FALCON Audit. As elective activity resumed in most units it was felt that it was an opportune moment for a UK-wire collaborative effort to help answer important questions about VTE and inform our future practice.

The primary aim was to analyse the 90-day incidence of symptomatic VTE related to elective foot and ankle surgery, trauma foot and ankle surgery and following the treatment of Achilles tendon ruptures (operative and non-operative).

Secondary aims were to assess the chemical anticoagulation variability in the UK and assimilate risk factors associated with development of symptomatic VTE in foot and ankle surgery in the UK.

 

Design

UK-wide Multicentre prospective national audit. Looked at datqa from 11,363 foot and ankle patients who underwent surgery in an operating theatre (or treatment for Achilles tendon ruptures) between the 1st of June to 30th of November 2022.  

 

Results

The study is now completed and the results will be published in the form of a report shortly. 

 

Acknowledgements

We would like to extend our gratitude to all the members who participated in this important national foot and ankle project – without your efforts this would not have been possible.

We would also like to acknowledge University of Leicester Hospitals Charity for funding the project, and NIHR Leicester Biomedical Research Centre for managing the data.