title: Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis.
abstract: OBJECTIVE
  The prevalence of peripheral arterial disease (PAD) and especially of critical limb ischaemia (CLI) is announced to rise dramatically worldwide, with a considerable impact on the health care and socio-economic systems. We aimed to characterize the recent trends in morbidity and in-hospital outcome of PAD among all hospitalized patients in the entire German population between 2005 and 2009.
  
  
  RESULTS
  Nationwide data of all hospitalizations in Germany in 2005, 2007, and 2009 were analysed regarding the prevalence of PAD, comorbidities, endovascular (EVR) and surgical revascularizations (SR), major and minor amputations, in-hospital mortality, and associated costs. From 2005 to 2009, total PAD cases increased by 20.7% (from 400 928 to 483 961), with an increase of CLI subset from 40.6 to 43.5%. Total EVR increased by 46%, while thromb-embolectomy, endarterectomy, and patch plastic increased by 67, 42, and 21%, respectively. Peripheral bypasses decreased by 2%. Major amputation decreased from 4.6 to 3.5%, while minor amputation slightly increased from 4.98 to 5.11%. The crude overall in-hospital mortality remained unchanged in claudicants (2.2%), while it decreased from 9.8 to 8.4% in CLI patients. However, mortality rate according to the Poisson model (n/1000 hospital residence days) increased significantly in claudicants (P < 0.001). Total reimbursement costs for PAD in-patient care increased by 21% with an average per case costs in 2009 of €4506 in a claudicant and €6791 in a CLI patient.
  
  
  CONCLUSIONS
  This population-based analysis documents the significant rise of PAD, particularly of the CLI subset, and highlights the malign prognosis associated with PAD as indicated by high amputation and in-hospital mortality rates.
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, A1, 48149 Muenster, Germany.
authors.forename: Nasser
authors.initials: N
authors.lastname: Malyar
authors.forename: Torsten
authors.initials: T
authors.lastname: Fürstenberg
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wellmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Meyborg
authors.forename: Florian
authors.initials: F
authors.lastname: Lüders
authors.forename: Katrin
authors.initials: K
authors.lastname: Gebauer
authors.forename: Holger
authors.initials: H
authors.lastname: Bunzemeier
authors.forename: Norbert
authors.initials: N
authors.lastname: Roeder
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D057510:Endovascular Procedures / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D018588:Fee-for-Service Plans; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000191:economics / Q000401:mortality*; D015424:Reperfusion / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data
keywords: Amputation; Critical limb ischaemia; In-hospital mortality; Peripheral artery disease; Revascularization