Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

Abstract

Background: Whether they are defined as minor or major, lower limb amputations constitute a severe health problem, causing high rates of morbidity and mortality and considerable social impact. Different patient clinical characteristics appear to be related to different types of amputations. Objectives: To analyze risk factors present in patients who underwent lower limb amputations at a tertiary hospital. Methods: This was a retrospective, cross-sectional study of 109 patients who underwent lower limb amputations over a period of 31 months, analyzing gender, age, 15 clinical data and five laboratory parameters present at the time of admission. Data were treated with descriptive statistics and compared using Student' s t test for unpaired samples (for numerical variables), the Mann-Whitney test, or Fisher' s exact tests (for categorical variables). Results: There were 59 major and 50 minor amputations out of a total of 109 performed. The majority of patients were male (65%) and mean age was 65 years (range 39 to 93). Risk factors that were statistically (p < 0.05) more related to major amputations were advanced age, stroke, ischemia, sepsis, and low hemoglobin and hematocrit levels. Diabetes mellitus, neuropathy, and palpable distal pulses were factors more strongly associated with minor amputations. Conclusions: Lower limb amputations at different levels are related to different risk factors. Ischemia of greater severity and morbidity was associated with major amputations, while neuropathy and preserved perfusion were more often related to minor amputations.

Caracterização das pessoas amputadas de um hospital de grande porte em Recife (PE, Brasil)

“…16 In contrast, LL amputations are more common among older people and are mostly related to non-traumatic causes, such as DM and vascular diseases. 3,10,17,18 In this study, upper limb amputations accounted for a much lower percentage than LL amputations, involved a younger age group, and the majority were caused by traumatic events.…”

“…It was found that the majority of patients who underwent amputations were elderly, which is a similar result to those of previous studies of amputation, particularly non-traumatic amputations. 3,9,10 In this study, the majority of amputated patients were male, which may be because men are less likely to seek health care, are more exposed to risk situations, and are more likely to neglect their health care. 11 A study conducted in the United States showed that men are more likely to undergo LL amputations and suggested that women have higher mortality rates associated with these amputations, both of which were characteristics also observed in this study.…”

“…6 With regard to this issue, there are studies indicating that the incidence of major amputations may be more related to vascular causes, because of atherosclerotic disease and DM. 3 A study by Borges 15 with patients with chronic LL ischemia indicated that the most common risk factors for major amputations observed were chronic kidney disease, coronary artery disease, uncontrolled DM, arterial aneurysms, previous amputations, and lack of primary care.…”

“…Amputations are generally performed as a last resort in an attempt to reinstate a person's health, when all other options have already been employed or are unfeasible, whether because of irreversible ischemia or trauma with excessive destruction of the limb involved. [1][2][3] Causes that lead to amputation include infectious and parasitic diseases, diseases of the circulatory apparatus, diabetes mellitus (DM), gangrene, diseases of the musculoskeletal system and the connective tissues, cancer, external causes, skin diseases, and congenital malformations. 2 Amputation procedures may therefore by urgent operations or may be scheduled electively.…”

Perfil da resiliência em indivíduos com amputação de membro inferior

“…Indivíduos com maior vulnerabilidade e alta exposição ao stress apresentam maior resiliência, graças a capacidade de ajustamento e adaptação perante a uma situação de vulnerabilidade. [31][32][33][34] O Diabetes Mellitus e a Hipertensão Arterial Sistêmica foram significativas nos amputados e cerca de 35 Borges 36 e podem indicar um risco para novas amputações. Segundo a Carga Global de Doença (GBD -Global Burden of Diseases) essas comorbidades estão associadas a um aumento de incapacidades e consequentemente de anos de vida sadia perdidos.…”