SUS performed, on average, 85 daily leg or foot amputations in 2022

More than 282,000 lower limb amputation surgeries (legs or feet) were performed in the Unified Health System (SUS) from January 2012 to May 2023. Last year alone, records reached the mark of 31,190 procedures performed, which which means that, every day, at least 85 Brazilians have their feet or legs amputated in the public network.

The data is part of a survey produced by the Brazilian Society of Angiology and Vascular Surgery (SBACV), which warns of the increase in this type of procedure across the country. According to the entity, there are states where the volume of amputations increased by more than 200% from 2012 to 2013.

“The data suggests a progressive increase in the number of amputations and disarticulations of lower limbs in Brazil. The survey reveals that the data accumulated in 2023 projects this year as the worst in the historical series that began in 2012”, highlighted the entity.

“The probability of these numbers being exceeded in 2023 is already drawn based on data from the first 5 months of the year. The survey shows that at least 12,753 surgeries were performed between January and May this year, a number higher than the 12,350 records for the same period in 2022”, warns the entity.

Diabetes

The study also raises an alert for care aimed at vascular diseases, such as diabetic foot syndrome. SBACV data show that more than half of amputation cases involve people with diabetes.

However, this type of surgery on the lower limbs may also be related to other risk factors, such as smoking, high blood pressure, dyslipidemia, advanced age, chronic renal failure, hypercoagulable states and family history.

Another worrying fact highlighted by the entity involves the lack of knowledge on the part of patients about their health status. Worldwide, it is estimated that one in five people does not know they have the disease. As a result, many patients arrive at the office or emergency services already with complications.

“Patients with diabetes and foot ulcers have a mortality rate twice as high compared to diabetic patients without foot ulcers. Those undergoing major amputation of a lower limb have low survival rates”, explains the entity.

Data show that around 10% of patients who have a lower limb amputated die in the perioperative period, which includes the preoperative phase, the operative phase and the postoperative period.

Furthermore, 30% die within the first year after amputation; 50% in the third year; and 70%, in the fifth. “This percentage may be higher in developing countries, as the demand for medical assistance usually occurs when the ulcer infection is advanced.”

National scenario

The accumulation of procedures carried out from January 2012 to May 2023, in absolute numbers, is greatest in the Southeast and Northeast regions. The first is responsible for more than 42% of all surgeries performed in Brazil, with a total of 118,962 procedures. In the Northeast, 92,265 amputations or demobilizations of lower limbs were carried out during this period. Next comes the South, with 39,952 records; the North, with 15,848; and the Central-West, with 15,546 records.

States

According to the survey, Alagoas was the federative unit that suffered the greatest increase in the number of amputations, with growth of 214% in the comparison between the beginning and end of the historical series — a jump from 182 to 571 procedures.

Other states that registered significant changes in the same period were Ceará, with a variation of 175%; Amazonas, up 120%; and Bahia and Rondônia, with growth of 83% in the comparison between 2012 and 2022.

On the other hand, Roraima and Pernambuco were the states where the lowest increase was observed using the same analysis method, with growth of 12% and 18%, respectively.

In absolute numbers, the states that performed the most lower limb amputation procedures in the SUS in 2022 were São Paulo (59,114), Minas Gerais (29,851), Rio de Janeiro (24,465), Bahia (24,395), Pernambuco (18,523) and Rio Grande do Sul (16,269).

The states with the lowest number of records are Amapá (376), Roraima (398), Acre (688), Tocantins (1,356) and Rondônia (1,606).

Expenses

The study highlights that, in addition to representing a serious public health problem, the increase in the number of amputations has a strong impact on public coffers, consuming part of the health funds allocated to the states. In 2022, R$78.7 million was spent on procedures of this type and, throughout the historical series, R$799 million was spent, a national average of R$2,962.28 per procedure.

Prevention

“In the case of diabetes, whose patients are the biggest victims of amputations, carelessness that is small for some people can lead to big problems. A small wound can result in infection, which evolves into a serious case of gangrene, raising the risk of amputation”, warns the entity.

According to the Brazilian Society of Angiology and Vascular Surgery, diabetes impacts blood circulation and causes narrowing of the arteries, causing a reduction in tissue oxygenation and nutrition rates. Furthermore, deformities in the feet and changes in sensitivity increase the chance of small injuries appearing and increase their progression to more serious cases.

Studies show that 85% of amputations related to diabetes begin with an injury to the feet, which could be prevented or treated correctly, avoiding complications.

Diagnosis

The entity considers that the delay in diagnosing diabetic foot syndrome means that the patient is only referred to a specialist when the problem is already at an advanced stage.

People with diabetes should be aware of precautions related to controlling blood glucose levels and the symptoms that can be observed during daily self-examinations.

“Most of these amputations could have been avoided through self-observation practices. A well-informed patient, who examines himself frequently, can recognize the need for early intervention at the first symptoms. Identifying early warning signs is essential to reduce the incidence of complications”, he recommends.

Care

Some measures, according to the entity, can reduce the risk of complications in the feet of diabetic people. Eating a balanced diet, practicing physical activity and maintaining blood glucose control, for example, contribute to improving the vascular system as a whole.

Patients with this risk factor must also be aware of the dangers of accidents and adopt behavioral changes, such as avoiding walking barefoot.

Check out other measures cited by the entity for preventing diabetic foot:

• Do not use cold, warm, hot or cold compresses or foot baths. Due to the lack of sensitivity caused by neuropathy, the patient may not notice injuries to the feet;
• Wear socks without seams or with the seams out. This way, the patient avoids friction between the rough part of the tissue and the skin;
• Do not remove cuticles from toenails. Any injury, no matter how small, can be a gateway for infections;
• Do not wear sandals with straps between the toes;
• Cut your nails straight and hit the corners with a nail file, taking due care;
• Moisturize your feet, as dry skin favors the appearance of cracks and injuries;
• Never go barefoot. The patient may not feel that the floor is hot or that they have cut their foot;
• Always look at the soles of your feet and treat any scratches, cracks or injuries immediately. If you are unable to do this alone, ask a family member or friend for help;
• Do not wear tight or pointy shoes;
• Treat calluses with healthcare professionals;
• Always look inside your shoes before using them;
• Wipe well between your fingers after bathing, swimming pool or beach.