Pulmonary embolism in young people. Trends in Germany from 2005 to 2011.

OBJECTIVES: There is an ongoing discussion about the impact of hormonal contraception on the incidence of venous thromboembolism (VTE) in young women. Specific data of the significance of this problem and its changes in recent years in Germany are not available. Thus, we analyzed the incidence of VTE in hospitalized young patients and looked for gender-specific differences. PATIENTS AND METHODS: Detailed lists of all pulmonary embolisms (PE) coded as I26 and deep vein thrombosis (DVT) coded as I80 in patients aged 10 to 39 years hospitalized in the years 2005 to 2011 were provided by the Federal Statistical Office. RESULTS: Beginning at the age of 12-13 years girls have higher numbers of PE and DVT documented as principal diagnosis, as compared to boys. This gender-specific difference disappears at the ages of 32-33 years. The difference in total numbers of PE (as principal diagnosis) between women and men within this 20-year time span increased from 318 in 2005 to 606 in 2010 and decreased to 505 in 2011. Stratifying the cases of PE according to presence or absence of cor pulmonale, the analysis showed a specific increase of PE in young women without cor pulmonale within the period of seven years between 2005 and 2011. Similar changes could not be shown for DVT as principal diagnosis. CONCLUSION: The presented data from the German DRG statistics show a disproportionally higher increase of young women hospitalised for pulmonary embolism as principal diagnosis in recent years. The possible impact of hormonal contraception on this increase has to be further elucidated.

Endovascular abdominal aneurysm repair: trends in Germany.

BACKGROUND: As a minimally invasive technique endovascular aneurysm repair (EVAR) reduces the risk of mortality and should be the preferred technique used in older patients. We analysed trends in endovascular and open surgical procedures in patients hospitalized for abdominal aortic aneurysm (AAA) in Germany. PATIENTS AND METHODS: We used national statistics (DRG statistics) published by the Federal Office of Statistics in Germany to calculate the incidence of patients hospitalised with ruptured (rAAA) and elective (eAAA) AAA. In addition, annual procedure rates of endovascular (EVAR) procedures were calculated. RESULTS: Incidence rates of eAAA per 100,000 males (females) showed a small increase from 2006 to 2007 but remained almost unchanged with 74.8 (8.8) in 2007 and 74.5 (9.8) in 2009. Incidence rates of rAAA per 100 000 males remained unchanged but showed a decreasing trend in females. The rate of people treated by EVAR increased form 2006 to 2009: in males from 24.0 % to 40.3 % and in females from 17.3 % to 31.0 %. In younger males (55 - 60 years) the increase in those who received EVAR was smaller (from 22.1 % to 33.9 %) than in older males (85 - 90 years) (from 20.4 to 41.6 %). Despite a clear increase in the use of EVAR from 2006 to 2009 there is only a small trend in reduction of the death rates which is more pronounced in rAAA. CONCLUSIONS: There has been a relevant increase in EVAR procedures for the treatment of AAA in Germany in recent years. Parallel to this increase of EVAR, aneurysm-related in-hospital deaths seem be declining slightly. A causal relationship between these trends remains to be proven.

Trends in lower extremity surgical and endovascular revascularization in Germany.

BACKGROUND: We analyzed trends in lower extremity endovascular and open surgical procedures in hospitalized patients in Germany. PATIENTS AND METHODS: We used national statistics (DRG statistics) published by the Federal Statistical Office including data from almost all hospitals in Germany to calculate annual procedure rates of lower extremity endovascular and open surgical procedures in the years 2005 to 2008. Detailed lists of the OPS-codes 8 - 836, 5 - 381, 5 - 393 separated by the 6th number of the code were analyzed regarding procedures representing revascularization of peripheral arteries including the aorta. RESULTS: Between 2005 and 2008 the total number of endovascular procedures increased from 73,584 to 98,664 and the number of surgical procedures from 74,789 to 86,172 a year. Age-adjusted incidence rates of endovascular procedures in people >= 65 years increased from 325 to 432 per 100,000 while the incidence rates of all open surgical procedures increased from 315 to 351 per 100.000. Looking only at bypass surgery the incidence remained unchanged with 177 and 176 per 100,000 in the same period. Endovascular procedures other than balloon angioplasty including percutaneous atherectomy, laser recanalization or usage of cutting balloon, account for less than 1 % in Germany. CONCLUSIONS: The numbers of endovascular procedures overweigh the numbers of open surgical procedures for treatment of lower extremity PAD in Germany today. In contrast to data from the USA we could not demonstrate a decrease of open surgical procedures in Germany in recent years.

Trends in amputations in people with hospital admissions for peripheral arterial disease in Germany.

BACKGROUND: Using the information of the federal statistics, a detailed description of the hospitalisation rate for amputation in Germany was possible for the first time, and trends since 2005 can be reported. PATIENTS AND METHODS: Detailed lists of all amputations coded as minor amputations (OPS 5 - 864) and major amputations (OPS 5 - 865) performed in 2005 and 2008, divided into the 4th and 5th number of the OPS-code, were provided by the Federal Statistical Office. RESULTS: Despite an increase in total number of hospitalized patients suffering from peripheral arterial disease and neurovascular disease there is a relevant decrease in age adjusted major amputation rates per 100.000 population in Germany from 27.0 in 2005 to 25.1 in 2008 in males and from 19.7 in 2005 to 17.1 in 2008 in females. Overall minor amputation rates do not show such a decrease but increased in males (from 47.4 in 2005 to 53.7 in 2008) und remained unchanged in females (23.1 in 2005 and 23.1 in 2008). In the 6th and 7th decade of life males have approximately four times higher major and minor amputation rates than females. CONCLUSIONS: Hospitalisation rate for major amputation in Germany decreased in the recent years whereas hospitalisation rate for minor amputation did not.