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There is a paucity of data on the relationship between hospital procedural volume and outcomes after inpatient treatment of symptomatic peripheral arterial disease (PAD). This study aimed to generate meaningful hypotheses to support the ongoing discussion.Data derived from Germanys second largest insurance provider, BARMER, were linked with nationwide hospital procedural volume from mandatory hospital quality reports. All endovascular (EVR) and open-surgical revascularisations (OSR) provided to patients (≥40y) with symptomatic PAD between 1There were 88,187 revascularisations (72.4% EVR; EVR: 72.7 years and 45.2% females; OSR: 71.9 years and 41.9% females) registered by 668 hospitals. For 12-month freedom from reintervention, no statistically significant association with hospital volume was found (EVR: 4. Quartile HR: 1.05, 95% CI: 0.94-1.16; OSR: 4. Quartile HR: 1.05, 95% CI: 0.92-1.21). Patients with OSR had a decreased hazard of 12-month mortality in a high-volume hospital compared to a low-volume hospital (HR: 0.85, 95% CI: 0.73-0.98), but not with EVR (HR 1.03, 95% CI: 0.91-1.16). Patients who were treated in hospitals with highest volumes showed decreased hazards of 12-month freedom from amputation when compared with low-volume hospitals (EVR: HR 0.72, 95% CI: 0.52-0.99; OSR: HR 0.61, 95% CI: 0.44-0.85).This large retrospective analysis of insurance claims suggests that higher procedural volume is associated with lower major amputation rates, although there is a need for standardisation of definition of volume stratification. Future studies should address the impact of subsequent outpatient care and surveillance to further examine the complex interaction between treatment and outcomes. |
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