{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:00:48Z","timestamp":1792807248220,"version":"4.5.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T00:00:00Z","timestamp":1649980800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T00:00:00Z","timestamp":1649980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Intervent Radiol"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To analyze trends and differences of endovascular, surgical and hybrid revascularization approaches and the impact of comorbidity on characteristics, costs, and outcome of in-patients with peripheral artery disease (PAD) of the lower extremity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Analyzing data provided by the Research Data Center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine IIb (Rutherford 2\u20133) or higher in Germany between 2009\u20132011 and 2016\u20132018. According to the individually performed procedures encoded by the Operation and Procedure Classification System, we divided hospitalizations by revascularization procedures into sole endovascular, sole surgical, hybrid, two-step and no revascularization. Patient\u2019s comorbidity was assessed using the linear van Walraven comorbidity score (vWs).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>1,067,671 hospitalizations (mean age 71.3\u2009\u00b1\u200911.1\u00a0years; 60.1% male) were analyzed. Between 2009\u20132011 and 2016\u20132018, reimbursement costs rose by 28.0% from \u20ac2.72 billion (\u20ac5,350\/case) to \u20ac3.49 billion (\u20ac6,238\/case). The share of hospitalizations with any revascularization increased by 8.9% (67.7\u201373.7%) driven by an increase in two-step (+\u200963.3%), hybrid (+\u200958.2%) and sole endovascular revascularizations (+\u200932.6%), while sole surgical approaches declined (\u2212\u00a018.2%). Hospitalizations of more comorbid patients (vWs\u2009\u2265\u200920) rose by 46.8% (21,444\u201331,478 cases), showed an overproportionate increase in costs of 124.6% (+\u2009\u20ac1,750\/case) and were associated with more individual procedures (+\u200990.6%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In-patient treatment of PAD patients shows increasing numbers of hybrid and sole endovascular revascularizations and more patients with higher comorbidity, while sole surgical interventions and in-hospital mortality decrease. Consequently, associated costs are surging especially in more comorbid patients due to an increasing number of performed procedures and escalation of therapy.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00270-022-03136-9","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T17:09:21Z","timestamp":1650042561000},"page":"1472-1482","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 Million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018"],"prefix":"10.1007","volume":"45","author":[{"given":"Josua A.","family":"Decker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Helmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Bette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Schwarz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4889-1036","authenticated-orcid":false,"given":"Thomas J.","family":"Kroencke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Scheurig-Muenkler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,15]]},"reference":[{"key":"3136_CR1","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","volume":"392","author":"SL James","year":"2018","unstructured":"James SL, Abate D, Abate KH, et al. 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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.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"For this type of study, informed consent is not required.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}