The number of lower limb amputations grows in Brazil; more than half involve diabetics – News



The number of lower limb amputations increased significantly in Brazil during the Covid-19 pandemic. On average, 66 patients undergo this type of surgery daily. However, in 2020, when the health crisis took hold in the country, the average jumped to 75.64.

The following year, it reached 79.19, the highest number of procedures, totaling 28,906 cases. The data are from a survey by the SBACV (Brazilian Society of Angiology and Vascular Surgery). For specialists, the problem would be related to the discontinuity in the follow-up of patients with chronic diseases during the period.

More than half of amputation cases involve people with diabetes, although the problem can also be related to many other risk factors, such as smoking, high blood pressure, advanced age, chronic kidney failure, hypercoagulable states and family history.

Between 2012 and 2021, the period of the survey, 245,000 Brazilians suffered amputation of legs, feet or fingers. The work, based on data from the Ministry of Health, shows that, in this period, in general, the increase in the number of procedures was 53% – which has worsened in the last two years.

The probability that the 2021 number, considered the highest, will be surpassed in 2022 is high, as the daily average of procedures in the first three months of this year is 82.




The vast majority of medical procedures fell sharply during the pandemic. In the case of amputations, however, an increase was recorded. For specialists, this was due to the difficulty in monitoring the health complications of patients who, during the health emergency, abandoned treatments and avoided going to hospitals and offices for fear of contamination by the virus.

As a result, many ended up going to the hospital only in the most serious situations, in which it was no longer possible to avoid amputation. For vascular surgeon Mateus Borges, director of SBACV, “these data demonstrate the impact of the pandemic on the care and quality of life of patients”.

According to him, people with diabetes who develop ulcers and progress to infectious conditions require long periods of hospitalization or readmission, with consequent periods of loss or absence from work, early retirement and, sometimes, a drop in self-esteem, depression or the creation of a condition of dependence on family or friends.

Another worrying fact is the individual who has diabetes and does not know it. This was the case of Luís Cardoso, 55, from Minas Gerais, who works in rodeos in the countryside of São Paulo. When he was diagnosed with the disease, it was too late to save his left big toe. “I was in the interior of São Paulo and had to go to Belo Horizonte to see the doctor, and I already had my thumb removed,” he said. “In 2020 I had an infection problem and had to take the other four fingers off.”

During the pandemic, Luís Cardoso also faced difficulties. “The highways were closed and it was difficult for me to go to Belo Horizonte to see my doctor,” he said. “Last October, I wore a shoe that hurt my foot and had to take the middle toe off my right foot. But I’m fine, it’s all under control.”

In absolute numbers, the states that most performed lower limb amputation procedures in the public system were São Paulo (51,101), Minas Gerais (26,328), Rio de Janeiro (21,265), Bahia (21,069), Pernambuco (16,314) and Rio Grande do Sul (14,469). On the other hand, the states with the lowest number of records are Amapá (315), Roraima (352), Acre (598), Tocantins (1,154) and Rondônia (1,383).



impacts


In addition to representing a serious public health problem, the constant growth in the number of amputations in the country has strong impacts on the public coffers, consuming part of the health funds allocated to the states. In 2021 alone, BRL 62,271,535.96 was spent on procedures performed throughout Brazil.

Between January 2012 and March 2022, considering the inflation of each year, BRL 660,021,572.69 were spent, which represents a national average of BRL 2,685.08 per procedure.

“This volume of expenses could be avoided if health systems invested more in preventive measures, especially in the follow-up of diabetic patients (…) so that drastic measures, such as amputation of limbs, are not taken”, explains the president of SBACV, Julio Peclat.

In the case of diabetes, whose patients are the biggest victims of amputations, carelessness can lead to big problems. A small wound can result in an infection that progresses to a serious case of gangrene, increasing the risk of amputation.

Diabetes impacts blood circulation because it causes the arteries to narrow, causing a reduction in tissue oxygenation and nutrition. Sensitivity changes increase the risk of small injuries and potentiate their evolution to more serious cases.




Studies show that 85% of diabetes-related amputations start with a foot injury that could have been prevented or treated correctly, avoiding complications.

“People with diabetes, over the years, develop neuropathy and/or ischemia, which makes them more susceptible to the development of wounds that are difficult to heal. [úlceras] and infections,” explains Peclat. “Neuropathy leads to a loss of sensitivity to touch, temperature, and pain. With this, the individual does not feel when the foot is injured. In general, by not realizing it, it evolves into infection conditions that result in debridement. [remoção de tecidos] or amputations.”

Vascular surgeon Eliud Duarte Junior says that “most of these amputations could have been avoided with self-observation practices. The well-informed patient who is frequently examined may recognize the need for early intervention at the very first symptoms. early treatment is essential to reduce the incidence of complications”.

Patients with this risk factor should also be aware of the dangers of accidents and adopt behavioral changes, such as avoiding walking barefoot or even adhering to the use of appropriate footwear.

“Long before any major complication arises, the patient may feel pain in the legs, which is a sign of poor blood circulation and clogged arteries”, explains vascular surgeon Brenno Caiafa.


Some precautions to avoid the problem

– Do not use cold, warm, hot or cold compresses or foot baths. Because of the lack of sensation caused by neuropathy, you may not notice foot injuries.

– Wear socks with no seams or with the seam out. This way you avoid rubbing the rough part of the fabric with the skin.

– Do not remove the cuticle of the toenails. Any injury, no matter how small, can be a gateway to infections.

– Do not wear sandals with straps between the toes.

– Cut the nails straight and hit the corners with sandpaper, but very carefully.

– Hydrate your feet, as dry skin favors the emergence of cracks and injuries.

– Never go barefoot. You may not feel that the floor is warm or that you have cut your feet.

– Always look at the soles of your feet and immediately treat any scratches, cracks or injuries. If you can’t do this on your own, ask a family member or friend for help.

– Do not wear tight or pointed shoes.

– Treat calluses with health professionals.

– Always look inside the shoes before using them.

– Dry the skin well between the toes after bathing, swimming or going to the beach.


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