The In-Hospital Care of Patients With Peripheral Arterial Occlusive Disease—the Effects of Hospital Size and

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Josua A Decker1, Florian Schwarz, Thomas J Kroencke

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

Deutsches Arzteblatt International
|June 23, 2022
PubMed

Insights

Treatments in certified vascular centers for peripheral arterial occlusive disease (PAOD) resulted in fewer major amputations but more minor amputations. Hospital size also impacted outcomes, with larger hospitals showing higher mortality and amputation rates.

Area of Science:

  • Vascular Surgery
  • Health Services Research
  • Health Outcomes

Background:

  • Previous studies indicated variations in peripheral arterial occlusive disease (PAOD) treatment outcomes based on hospital size and certification in Denmark and the USA.
  • The impact of hospital specialization and size on PAOD treatment outcomes in Germany remained uninvestigated.

Purpose of the Study:

  • To determine if hospital certification as a specialist vascular center or hospital size influences primary treatment outcomes for patients with peripheral arterial occlusive disease (PAOD) in Germany.

Main Methods:

  • Analysis of nationwide German hospital data for PAOD (Fontaine stage IIb or higher).
  • Hospitals were categorized by size and certification status (specialist vascular center).
  • Logistic regression models were used to identify predictors of treatment endpoints, adjusting for patient factors like PAOD stage, age, sex, and comorbidities.

Main Results:

  • Over 558,000 hospitalizations for PAOD were analyzed; 29% were in certified vascular centers.
  • Admissions to certified hospitals correlated with reduced major amputation rates (OR 0.95) and increased minor amputation rates (OR 1.04).
  • No significant difference in mortality was observed between certified and non-certified hospitals (OR 0.99).
  • Larger hospitals were associated with higher comorbidity burden, longer stays, and increased rates of mortality and amputations.

Conclusions:

  • Treatment at certified vascular centers is linked to a decrease in major amputations and an increase in minor amputations for PAOD patients.
  • This suggests a potential benefit of specialized care in limb preservation strategies.
Abstract

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