Brazil sees record number of lower‑limb amputations
More than 282 thousand lower-limb amputation surgeries were performed in public hospitals across Brazil from January 2012 to May 2023. Last year alone, 31,190 procedures were carried out, which means that every day at least 85 Brazilians had their feet or legs amputated through the country’s national healthcare system, the SUS.
The figures can be found in a survey by the Brazilian Society of Angiology and Vascular Surgery, which warns of an increase in this type of procedure countrywide. According to the organization, some states have seen a surge in the number of amputations of more than 200 percent from 2012 to 2013.
The Angiology Society has noted a progressive rise in the number of lower-limb amputations and disarticulations in Brazil. The data up to 2023 suggest that this year will be the worst in the time series that began in 2012.
“The likelihood of these figures being exceeded in 2023 is clear from the data for the first five months of the year. The survey shows that at least 12,753 surgeries were carried out between January and May this year, a figure higher than the 12,350 recorded for the same period in 2022,” the organization reported.
Diabetes
The study also raises awareness about vascular diseases—like diabetic foot syndrome. It shows that more than half of all amputations involve people with diabetes, although they may also be related to other risk factors, such as smoking, high blood pressure, dyslipidemia, old age, chronic renal failure, hypercoagulable conditions, and family history.
Another worrying fact stressed by the organization is the lack of patients’ knowledge about their own condition. Worldwide, one in five people are estimated to be unaware they have the disease. As a result, many patients arrive at the doctor’s office or emergency room already suffering from complications.
“Patients with diabetes and foot ulcers have a mortality rate twice as high as diabetic patients without them. Those undergoing major amputation of a lower limb have low survival rates,” the organization underscored.
The findings also indicate that approximately 10 percent of patients who have a lower limb amputated die in the perioperative period—which includes the pre-operative phase, the operative phase, and the post-operative period. In addition, 30 percent die in the first year after amputation, 50 percent in the third year, and 70 percent in the fifth year. “The percentage may be higher in developing countries, as the search for medical assistance usually occurs when the ulcer infection is advanced.”
In absolute numbers, the procedures done from January 2012 to May 2023 are most striking in Brazil’s Southeast and Northeast. The former accounts for over 42 percent of all surgeries performed in Brazil—with 118,962 procedures. In the Northeast, 92,265 lower-limb amputations or demobilizations were performed during this period. Next come the South, with 39,952, the North, with 15,848, and the Central-West, with 15,546 records.
Prevention
“In the case of diabetes, whose patients are the biggest victims of amputations, oversights considered minor by some people can lead to big problems. A small wound can result in an infection that evolves into a serious case of gangrene, raising the risk of amputation,” the text reads.
Diabetes also affects blood circulation and leads to the narrowing of arteries, causing a reduction in tissue oxygenation and nutrition. In addition, deformities in the feet and changes in sensitivity make small injuries more likely to develop into more serious cases, the society added.
Studies show that 85 percent of amputations linked to diabetes start with a foot injury, which could be prevented or treated correctly, thus avoiding complications.
The society believes that the delay in diagnosing diabetic foot syndrome means that patients are only referred to a specialist when the problem is at an advanced stage. People with diabetes should be vigilant about controlling blood glucose levels and the symptoms that can be observed during daily self-examinations.
Expenses
The document highlights that, in addition to representing a serious public health problem, the higher number of amputations has a strong impact on public coffers. In 2022, BRL 78.7 million was spent on procedures of this type and, over the entire time series, BRL 799 million was spent, a national average of BRL 2,962.28 per procedure.
