Amputación de miembro inferior en pacientes diabéticos del Hospital de Clínicas de Asunción – Paraguay. Una estimación de costos directos.

Alfredo Chaparro Cubilla, E Rodriguez Candia

Resumen


Una de las complicaciones crónicas más incapacitantes de la diabetes mellitus es la
insuficiencia vascular periférica que puede llevar a la amputación del miembro inferior. Objetivo:
Estimar los costos directos totales de los procedimientos quirúrgicos de amputaciones de miembro
inferior de causa diabética en pacientes que acudieron al Servicio de Urgencias del Hospital de
Clínicas de Asunción, Paraguay durante el año 2008.
Material y Método: Estudio descriptivo, de corte transversal de estimación y cálculos de costos
directos que realizaron los pacientes, el entorno familiar y el servicio de salud pública en los casos
de amputaciones de miembro inferior.
Resultados: Se registraron 65 amputaciones de miembro inferior de causa diabética distribuidas
de la manera siguiente: amputación de dedo 29,2%, amputación transmetatarsiana 14%, transtibial
30,7%, transfemoral 26,1%. El costo directo total respectivamente para cada tipo de amputación
fue de, en dólares americanos: 11,641.61; 8,314.69; 18,477.09; 15,705.53. El costo total de las
amputaciones ascendió a 54,138.93 dólares americanos.


Palabras clave


Amputación de miembro inferior; diabetes mellitus; costos de amputación

Texto completo:

PDF

Referencias


Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the

year 2000 and projections for 2030. Diabetes Care 2004;27(5):1047-53.

Barceló A, Aedo C, Rajpathak S, Robles S. The Cost of diabetes in Latin America and

Caribbean. Bulletin WHO 2003;81(1):19-27.

Jimenez JT, Palacios M, Cañete F, Barriocanal LA, Medina U, Figueredo R et al. Prevalence of

Diabetes Mellitus and associated cardiovascular risk factors in and adult urban population in

Paraguay. Diabet Med 1998;15(4):334-8.

Cañete F, Barceló A. [Diabetical Attention and Prevention, step by step in Paraguay] Spanish.

Diabet Voice 2006;51(1):9-11.

Rubin RJ, Altman WJ, Mendelson DN. Health care expenditures for people with diabetes

mellitus, 1992. J Clin Endocrinol Metab 1994;78(4):809A-809F.

Amos AF, Mc Carty DJ, Zimmet P. The rising global burden of diabetes and its complications:

estimates and projections to the year 2010. Diabet Med 1997;14(suppl) 5:S1-85.

Levin ME. Management of the Diabetic Foot: Preventing Amputation. South Med J

;95(1):10-20.

Green MF, Aliabadi Z, Green BT. Diabetic Foot: Evaluation and Management. South Med J

;95(1):95-101.

Goodridge D, Trepman E, Embil JM. Health-related quality of life in diabetic patients with foot

ulcers: literature review. J Wound Ostomy Continence Nurs 2005;32(6):368-77.

Coletta EM. Care of the Elderly Patient with Lower Extremity Amputation. J Am Board Fam

Pract 2000;13(1):23-34.

Rith-Najarian S, Stolusky T, Gohdes D. Identifying diabetic patients at high risk for lower

extremity amputations in a primary health care setting. A prospective evaluation of siple

screening criteria. Diabetes Care 1992;15(10):1386-9.

History of foot ulcer among persons with diabetes, United States, 2000 to 2002. Centers for

Disease Control and Prevention. MMWR 2003;52(45):1098-102.

Bloomgarden ZT. Nephropathy and neuropathy. America Diabetes Association Annul Meeting,

Diabetes Care 2000;23(4):549-56.

Moss SE, Klein R, Klein BEK. The 14-year incidence of Lower Extremity Amputations in a

Diabetic Population. The Wisconsin epidemiology study of diabetic retinopathy. Diabetes Care

;22(6):951-9.

Custom TM, Bongiorni DR. Rehabilitation of the older lower limb amputee: a brief review. J Am

Geriatr Soc 1996;44(11):1388-93.

Frykberg RG, Arora S, Pomposelli FB Jr, LoGerfo F. J Foot Ankle Surg 1998; 37(3):181-5;

Pernot HF, de White LP, Lindeman E, Cluitmans J. Daily functioning of the lower extremity

amputee: an overview of the literature. Clin Rehabil 1997; 11(2):93-106.

Centers for Disease Control and Prevention: Diabetes Surveillance. Atlanta US. Department of

Health and Human Services, Public Health Service, 1993.

Centers for Disease Control and Prevention: Lower Extremity Amputations Episodes Among

Persons With Diabetes – New Mexico 2000. MMWR 2003:52(4):66-8.

Jeffcoate WJ. The incidence of amputations in Diabetes. Acta chir belg 2005;105:140-4.21. Saar WE, Lee TH, Berlet GC. The economic burden of diabetic foot and ankle disorders. Foot

Ankle Int 2005;26(1):27-31.

Ali SM, Fareed A, Humail SM, Basit A, Ahmedani MY, FawwD a, Miyan Z. The personal cost of

diabetic foot diseasse in the developing world—a study from Pakistan. Diabet Med

;25(10):1231-3.

Davis WA, Norman PE, Bruce DG, Davis TM. Predictors, consequences and costs of diabetesrelated

lower extremity amputation complicating type 2 diabetes: the Fremantle Diabetes

Study. Diabetologia 2006;49(11):2634-41.

Brunerová L, Andêl M. [Calculations of the costs of dugs, medical materials, certain medical

procedures and social services for patients with diabetic foot syndrome] Article in Czech. Vnitr

Lek 2003;49(6):457-64.

Rezende KF, Nunes MA, Melo MH, Malerbi D, Chacra AR, Ferraz MB. [In Hospital care for

diabetic foot: a comparison between the estimated cost and the SUS reimbursement] Article in

Portuguese. Arq Bras Endocrinol Metabol 2008;52(3):523-30.

Habib SH, Biswas KB, Akter S, Saha S, Ali L. Cost –effectiveness analysis of medical

intervention on patients with early deection of diabetic foot in a tertiary care hospital in

Bangladesh. J Diabetes Complications 2009 Feb. [Epub ahead of print].

Rith-Najarian S, Branchaud C, Beaulieu O, Gohdes D, Simonson G, Mazze R. Reducing lower

extremity amputations due to diabetes. Application of the staged diabetes management

approach in a primary care setting. J Farm Pract 1998;47(2):127-32.

Boulton AJ, Vieleikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot

disease. Lancet 2005 ;366(9498):1719-24.

Pernot HF, Winnubst GM, Cluitmans JJ, De Witte LP. Amputees in Linburg: Incidence,

morbidity and mortality, prosthetic supply, care utilisation and functional level after one year.

Prosthet Orthot Int 2000;24(2):90-6.

Sweeney E. Cost of prosthetics stirs debate, Bill to boost coverage spurs industry, insurers to

lobby state lawmakers. The Boston Globe 2005 jul 5; Disponible en: URL:

http://www.boston.com/business/globe/articles/2005/07/05

Decreto nº 1.946/09 del Poder Ejecutivo de la República del Paraguay. Disponible en URL:

http://www.presidencia.gov.py

Ministerio de Hacienda, República del Paraguay. Resultados del Programa Económico 2007.

Elaborado por el Gabinete Técnico del Ministerio de Hacienda y el Banco Central del

Paraguay. Disponible en URL: http://www.hacienda.gov.py.


Enlaces refback

  • No hay ningún enlace refback.


Facultad de Ciencias Médicas. Universidad Nacional de Asunción

Dr. José P. Montero esquina Dr. Mario Mazzei
(Edificio de Ciencias Básicas)
C.P. 1120 Asunción - Paraguay



Contadores de visitas gratis para webCursosContadores de visitas gratis para web