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In-patient care trends in peripheral artery disease in the German healthcare system over the past decade

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To analyze trends of in-hospital treatment of patients admitted due to peripheral artery disease (PAD) from 2009 to 2018 with special focus on comorbidities, revascularization procedures, resulting costs, and outcome.

Methods

Using data from the research data center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine stage IIb or higher from 2009 to 2018. To analyze comorbidities, Elixhauser diagnostic groups and linear van Walraven score (vWS) were assessed.

Results

A total of 1.8 million hospitalizations resulting in €10.3 billion in reimbursement costs were included. From 2009 to 2018, the absolute number of hospitalizations due to PAD increased by 13.3% (163,547 to 185,352). The average cost per hospitalization increased by 20.8% from €5,261 to €6,356. The overall in-hospital mortality decreased from 3.1 to 2.6%. Median vWS of all PAD cases increased by 3 points (2 to 5). The number of percutaneous transluminal angioplasties (PTA) increased by 43.9% while some surgical procedures such as bypasses and embolectomies decreased by 30.8% and 6.8%, respectively. Many revascularization procedures showed a disproportionate increase of those performed in vessels below the knee for example in PTA (+ 68.5%) or in endarterectomies (+ 38.8%).

Conclusions

This decade-long nationwide analysis shows a rising number of hospitalizations due to PAD with more comorbid patients resulting in increasing reimbursement costs. Interventions are shifting from surgical to endovascular approaches with a notable trend towards interventions in smaller vessels below the knee.

Key Points

• The number of hospitalizations due to peripheral artery disease is rising and it is associated with increasing reimbursement costs.

• Admitted patients are older and show an increasing number of comorbidities while overall in-hospital mortality is decreasing.

• Revascularization procedures are shifting from surgical to endovascular approaches and show a trend towards intervention in smaller vessels below the knee.

• Major amputations are decreasing while the number of minor amputations is increasing.

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Abbreviations

BTK:

Below the knee

CFA:

Common femoral artery

DCB:

Drug-coated balloon

DFA:

Deep femoral artery

DRG:

Diagnosis Related Group

ICD-10:

International Classification of Diseases 10th Revision

OPS:

Operation and Procedure Classification System

PAD:

Peripheral artery disease

PTA:

Percutaneous transluminal angioplasty

RDC:

Research data center

SFA:

Superficial femoral artery

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany

    Josua A. Decker, Florian Schwarz, Thomas J. Kroencke & Christian Scheurig-Muenkler

  2. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA

    Josua A. Decker, Akos Varga-Szemes, U. Joseph Schoepf & Tilman Emrich

  3. Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany

    Tilman Emrich

  4. German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany

    Tilman Emrich

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  1. Josua A. Decker
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Corresponding author

Correspondence to U. Joseph Schoepf.

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Guarantor

The scientific guarantor of this publication is PD Dr. Christian Scheurig-Muenkler. Christian.schreurig@uk-augsburg.de

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Schoepf has received institutional research support and/or honoraria for speaking and consulting from Astellas, Bayer, Bracco, Elucid BioImaging, General Electric, Guerbet, HeartFlow Inc., and Siemens Healthineers. Dr. Varga-Szemes has received institutional research support from Siemens Healthineers and honoraria from Bayer and Elucid BioImaging. Dr. Emrich has received travel support and speaker honoraria from Siemens Healthineers. All other authors declare that there is no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because we assessed already anonymized data (anonymized by the federal statistical office of Germany) that was additionally subjected to a secrecy check censoring subgroups with fewer than five individuals in order to maintain the anonymity of individual cases.

Ethical approval

Institutional Review Board approval was not required because we assessed already anonymized data (anonymized by the federal statistical office of Germany) that was additionally subjected to a secrecy check censoring subgroups with fewer than five individuals in order to maintain the anonymity of individual cases.

Methodology

• retrospective

• cross-sectional study/observational

• performed at one institution

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Decker, J.A., Varga-Szemes, A., Schoepf, U.J. et al. In-patient care trends in peripheral artery disease in the German healthcare system over the past decade. Eur Radiol 32, 1697–1708 (2022). https://doi.org/10.1007/s00330-021-08285-y

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