Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário
Analysis of risk factors related to minor and major lower limb amputations at a tertiary hospital
Seleno Glauber de Jesus-Silva, João Pedro de Oliveira, Matheus Henrique Colepicolo Brianezi, Melissa Andreia de Moraes Silva, Arturo Eduardo Krupa, Rodolfo Souza Cardoso
Resumo
Contexto: As amputações dos membros inferiores, sejam definidas como maiores ou menores, são um grave problema de saúde, com altos índices de morbimortalidade e de relevante impacto social. Diferentes características clínicas dos pacientes parecem estar relacionadas aos diferentes tipos de amputação realizados. Objetivos: Analisar os fatores de risco presentes em pacientes submetidos a amputações de membros inferiores em hospital terciário. Métodos: Estudo retrospectivo, transversal, envolvendo 109 pacientes submetidos a amputação de membro inferior em um período de 31 meses, através da análise de gênero e idade, 15 dados clínicos e cinco parâmetros laboratoriais presentes no momento da admissão. Os dados foram submetidos a estatística descritiva e comparativa através do teste t de Student não pareado (para variáveis numéricas), e dos testes de Mann-Whitney e exato de Fisher (para variáveis categóricas). Resultados: Das 109 amputações realizadas, 59 foram maiores e 50 menores. A maioria dos pacientes era do gênero masculino (65%), e a média de idade foi de 65 anos (mín. 39, máx. 93). Dentre os fatores de risco observados, idade avançada, acidente vascular encefálico, isquemia, sepse e níveis baixos de hemoglobina e hematócrito estavam estatisticamente mais relacionados às amputações maiores (p < 0,05). Diabetes melito, neuropatia e pulsos distais palpáveis foram fatores mais associados às amputações menores. Conclusões: Os níveis das amputações de membros inferiores estão relacionados a diferentes fatores de risco. Os quadros isquêmicos mais graves e de maior morbidade estiveram associados a amputações maiores, enquanto a neuropatia e perfusão preservada, mais relacionados às amputações menores.
Palavras-chave
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.
Keywords
References
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