Dtsch Arztebl Int. 2022 Sep 5;(Forthcoming):arztebl.m2022.0235. doi: 10.3238/arztebl.m2022.0235. Online ahead of print.
BACKGROUND: Studies from Denmark and the USA have shown that the outcome of treatment of peripheral arterial occlusive disease (PAOD) varies as a function of the size and certification status of the treating hospital. It is not yet known whether this holds for Germany as well.
METHODS: We studied all hospitalizations for PAOD of stage IIb or higher (in Fontaine’s classification) using DRG statistics from the German Federal Statistical Office. The treating hospitals were classified by size and certification status. For each hospitalization, the patient’s PAOD stage, age, sex, and comorbidities were recorded. Independent variables predicting different endpoints of treatment were identified by univariate and multivariate logistic regression.
RESULTS: 29% of the 558 785 hospitalizations included in our analysis were in hospitals with certified vascular centers. In a multivariate analysis, hospitalization in a certified hospital was associated with a lower rate of major amputation (odds ratio [OR] 0.95; 95% confidence interval [0.92; 0.98], p = 0.003) and a higher rate of minor amputation (OR 1.04 [1.01; 1.06], p = 0.004), with no difference in mortality (OR 0.99 [0.96; 1.03], p = 0.791). Patients who were treated in larger hospitals had more extensive comorbidity, stayed longer in the hospital, and had higher amputation rates and a higher mortality.
CONCLUSION: Being treated for PAOD in a certified hospital is associated with fewer major amputations and more minor amputations. This may be due to greater utilization of treatments aimed at preserving limb function.