Amputações maiores de membros inferiores por doença arterial periférica e diabetes melito no município do Rio de Janeiro Major lower extremity amputations related to peripheral arterial disease and diabetes mellitus in the city of Rio de Janeiro

Objective: To estimate incidence rates of 4,818 major lower extremity amputations related to peripheral arterial diseases and diabetes mellitus performed in the city of Rio de Janeiro between the years of 1990 and 2000. Methods: Analysis of amputee registry and medical records, considering the following data: age, gender, amputation level, incidence rate from passive surveillance and capture-recapture systems. Chi-square test was used to compare proportions. Results: Primary major lower extremity amputations were 97.7% and the secondary ones 2.3%. In 43 hospitals included in the study, 56.3% of amputations were caused by peripheral arterial diseases whereas 43.7% by diabetes mellitus (P < 0.001), with frequency increasing from 1.2% to 22.9% for diabetes mellitus and from 4% to 19.4% for peripheral arterial diseases (P < 0,001). Males (M) and age groups ranging from 65-69 and 55-79 years influenced peripheral arterial diseases (P < 0,001). The average age was 64.89 (± 10.35) years for diabetes mellitus, and 66.36 (± 11.90) years for peripheral arterial diseases (P < 0.001). Primary major lower extremity amputations above knee were 71.8%, with 59.9% caused by peripheral arterial diseases and 40.1% by diabetes mellitus (P < 0,001). Ratio above/bellow knee was 3,2:1 (peripheral arterial diseases), and 1,9:1 (diabetes mellitus). Incidence rates increased five times; 18 and three times for diabetes mellitus and 19 and 2.2 times for peripheral arterial disease, in males and females respectively. Capture-recapture results were 20%, 370% and 350% higher (55-74 years) for the general population, diabetes mellitus, and peripheral arterial disease. Conclusion: The increased number of amputations as well as the high level of primary major lower extremity amputations, which represent a five times increase in frequency of this type of amputation, should be considered an important public health problem.