Surgery for leg or foot amputation grows 53% in Brazil in 9 years

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The number of surgeries in Brazil for leg and foot amputations increased by 53%, compared to 2012 with 2021, the second year of the Covid-19 pandemic.

A survey carried out by the Brazilian Society of Angiology and Vascular Surgery (SBACV) based on data from Datasus, from the Ministry of Health, shows that in 2012, 18,908 procedures were registered against 28,906 in 2021.

In 2012, there were 1,576 monthly amputations and 51.80 daily amputations, on average. Last year, the monthly average was 2,409 and the daily average was 79.19 — every hour, three Brazilians had to have their leg or foot amputated.

For vascular surgeon Julio Peclat, president of the entity, in the last two years, with fear of infection by the coronavirus, people stopped going to the doctor and abandoned the treatment of chronic diseases.

The consequence is the worsening of diabetes, kidney failure, hypertension and dyslipidemia — changes in cholesterol and triglyceride levels.

The complications of Covid-19, which attacks the vessels and leads to thrombosis, and smoking are also pointed out as causes of this increase.

“We can interpret these data in the sense that one of the main causes was decompensated diabetes. We saw that during the pandemic period there was a discontinuity in the treatment of chronic diseases, including diabetes. So, patients are more vulnerable to small injuries on the feet, and the immunity, more weakened”, says the specialist.

“At the beginning of the pandemic, we knew very little about Covid and the order was to stay at home. In this period, in many chronic diseases, patients no longer have care and now we are paying a very high price”, says Peclat.

Retired Marlene Nunes Lamônica, 66, resident in Magé, in the metropolitan region of Rio de Janeiro, did not neglect her health during the pandemic. Diabetic, she followed the guidelines for protection against the coronavirus and attended consultations to control the disease.

Even with all the care, an injury led to the amputation of the right big toe. “I spent a whole day wearing tight sandals and it aggravated a bruise I already had on top of my foot. It got infected. The infection went to the bone and gave osteomyelitis”, she says.

The doctor advised her to perform the amputation as soon as possible. The surgery took place on June 10 this year, at Samcordis Hospital, in São Gonçalo.

“I’m recovering well, the wound is dry, but I feel a big difference. I miss my finger. It’s a little piece that comes out of us, right? But it’s better to lose a finger than to lose your life.”

The increase in this type of surgery can be observed year after year, between 2012 and 2021. In the period, 238,391 people had a lower limb amputation — a monthly average of 1,987 and a daily average of 65.3.

By adding 2022 (until March), the total number of procedures reaches 245,811 — a monthly average of 2,031 and a daily average of 66.9.

The trend is that 2022 will continue with expressive rates, not least because there is a repressed demand. In 2023, the expectation is for a reduction in numbers, as health treatments have resumed.

The regions of the country with the highest percentage of increase in leg or foot amputation surgeries were the Northeast (56%) and Southeast (55%). Then come the Midwest (52%), North (47%) and South (43%).

Some states also had high rates. This is the case of Alagoas (173%), comparing the total of 2012 (182 surgeries) with that of 2021 (497).

In the same interval, in Roraima there was an increase of 160%; Ceará grew 146%; and Rondônia, 116%.

On the other hand, in Amapá and Amazonas, a reduction of 29% and 25%, respectively, is observed.

Two factors in diabetes increase the incidence of amputation.

One of them is diabetic neuropathy — blood glucose fluctuation causes loss of sensation in the feet, especially on the soles of the feet. With less sensitivity and less pain, minor injuries are overlooked.

The other is diabetic microangiopathy, an impairment of the microcirculation in the feet due to decompensated diabetes, according to the doctor.

“When diabetes is not disciplined, a high price is paid with mutilation and even life”, concludes the entity’s president.

Another worrying factor is underreporting, that is, the individual who has diabetes and does not know it. Worldwide, 1 in 5 people are unaware of having the disease.

“The pandemic has revealed this to us. Many who come to the office or emergency services with diabetes complications only discover that they have it after being treated. Brazil already has a legion of amputees, which grows exponentially”, says vascular surgeon Mateus Borges , Director of Publications at SBACV.

costs

Public coffers in the Southeast and Northeast regions were the most impacted in the country by expenses with amputation surgeries.

The Southeast was responsible for 103,509 procedures, which together cost R$ 302.9 million. São Paulo was the federative unit that spent the most: R$ 150 million for 51,101 operations.

The Northeast paid R$ 186 million for 80,124 surgeries. Pernambuco had the highest expenditure: R$ 42.3 million for 16,314 procedures.

“This volume of expenses could be avoided if health systems invested more in preventive measures, especially in the monitoring of diabetic patients. This public needs permanent and multidisciplinary attention so that drastic measures, such as amputation of limbs, are not taken”, explains Peclat.

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