The number of lower limb amputations is increasing in Brazil;  More than half include diabetics

The number of lower limb amputations is increasing in Brazil; More than half include diabetics

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

The following year, it reached 79.19, the highest number of procedures, with a total of 28,906. Data are from a survey conducted by SBACV (Brazilian Society of Vascular and Vascular Surgery). For specialists, the problem is related to the interruption of follow-up of patients with chronic diseases during this period.

More than half of the amputations involve people with diabetes, although the problem can also be linked 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 survey period, 245,000 Brazilians suffered amputations of their legs, feet, or fingers. The work, based on the data of 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 past two years.

The probability of exceeding the number of 2021, which is considered the highest, in 2022 is high, as the daily average of actions in the first three months of this year is 82.

The vast majority of medical procedures have fallen sharply during the pandemic. However, an increase in amputations has been recorded. For specialists, this was due to the difficulty of monitoring health complications for patients who, during the health emergency, abandoned treatment and avoided going to hospitals and offices for fear of contracting the virus.

As a result, many of them ended up going to the hospital only in the most serious cases, since amputation could no longer be avoided. For vascular surgeon Mateusz Borges, director of SBACV, “These data demonstrate the impact of the pandemic on patients’ care and quality of life.”

According to him, diabetics who develop ulcers and progress to infectious conditions require long periods of hospitalization or readmission, with consequent periods of missing or absent work, early retirement, and sometimes low self-esteem, depression or disposition. From the state of dependence on family or friends.

Another disturbing fact is the individual with diabetes does not know it. Such was the case of Luis Cardoso, 55, of Minas Gerais, who works as a rodeo in the Sao Paulo countryside. By the time he was diagnosed with the disease, it was too late to save his left toe. “I was in the interior of Sao Paulo and had to go to Belo Horizonte to see the doctor, and my thumb had already been removed,” he said. “In 2020, I had an infection problem and had to remove the other four fingers.”

During the pandemic, Luis Cardoso also had difficulties. “The highways were closed and it was hard for me to go to Belo Horizonte to see my doctor,” he said. “Last October I was wearing shoes that hurt my foot and had to dislocate my right toe. But I’m fine, everything is under control.”

In absolute numbers, the states that performed the most lower-limb amputations in the public system were São Paulo (51101), Minas Gerais (26328), Rio de Janeiro (21265), Bahia (21069), Pernambuco (16,314) and Rio Grande do Sul (14469). On the other hand, the states with the fewest records are Amapá (315), Roraima (352), Acre (598), Tocantins (1,154), and Rondônia (1,383).

Effects

In addition to being a serious public health problem, the continued growth in the number of amputations in the country has strong implications for the public treasury, as it consumes a portion of state health funds. In 2021 alone, R$62,271,535.96 was spent on procedures that were performed across Brazil.

Between January 2012 and March 2022, looking at inflation each year, R$660,021,572.69 was spent, representing a national average of R$2,685.08 per measure.

The president explained that “this volume of expenditures can be avoided if health systems invest more in preventive measures, especially in monitoring patients with diabetes (…) so that drastic measures, such as amputations, are not taken.” From SBACV, Julio Piclat.

In the case of diabetes, whose patients are the biggest victims of amputation, neglect can lead to major problems. A small wound can lead to an infection that develops into a serious case of gangrene, increasing the risk of amputation.

Diabetes affects blood circulation because it causes the arteries to narrow, which leads to reduced tissue oxygenation and nutrition. Sensitivity changes increase the risk of small infections and increase their progression to more serious conditions.

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

“People with diabetes have, over the years, developed neuropathy and/or ischemia, which makes them more likely to develop hard-to-heal wounds. [úlceras] and infections,” Peclat explains. Neuropathy leads to a loss of sensitivity to touch, temperature, and pain. With this, the individual does not feel when his foot is injured. Generally, by not realizing it, it develops into infections that lead to debridement. [remoção de tecidos] or amputation.”

Vascular surgeon Eliud Duarte Junior says that “most of these amputations could have been avoided through self-monitoring practices. An informed patient who is frequently checked may realize the need for early intervention at the first symptoms. Early treatment is essential to reduce the incidence of complications.”

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

“Long before any major complications appear, the patient may feel pain in the legs, which is a sign of poor circulation and blockage of the 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 without seams or with seams. This way you avoid rubbing the rough part of the fabric into the leather.

Do not remove the cuticle of the toenail. Any injury, no matter how small, can be a gateway to infection.

Do not wear sandals with laces between the toes.

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

Moisturize your feet, as dry skin favors the appearance of cracks and injuries.

– Don’t walk barefoot. You may not feel that the ground is warm or that you have injured your feet.

Always look at the soles of your feet and immediately treat any scrapes, 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.

Treating calluses with health professionals.

Always look inside the shoe before using it.

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

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