Reinecke et al. Outcome of PAD and CLI - Page 1
Supplementary Appendix
Table of Contents
Page
Table of Contents
1
Supplemental Figure S1: Patient identification and periods of data collection
2
Supplemental Figure S2: Patient allocation and classification
3
Supplemental Table S1: Diagnosis codes used for this analysis
4
Supplemental Table S2: Number of Patients with qualifying main and secondary
diagnosis
Supplemental Table S3: Used procedure codes
5
6
Supplemental Table S4: Multivariate Cox regression analysis for death during
follow-up, stratified by age quintiles
7
Supplemental Table S4: Multivariate Cox regression analysis for amputation
during follow-up stratified by age quintiles
8
Reinecke et al. Outcome of PAD and CLI - Page 2
Supplemental Figure S1: Patient identification and periods of data collection
Total pool of about 8 million insured patients
Hospital admission between Jan 1st, 2009 and Dec 31st, 2011
AND
Any hospitalization with qualifiying main diagnosis code
(see Methods and Supplementary Table S1 and Figure S2)
60,221 patients identified
Exclusion of patients without confirmed co-existing PAD
41,882 patients included
Diagnosis and procedural data collection
Jan 1st, 2009
Dec 31st, 2011
Index-hospitalization during Jan 1st, 2009 and Dec 31st, 2011
Dec 31st, 2012
24 months before hospitalization
Follow-up until Dec 31st, 2012
data collection during the 24 months
before index hospitalization
collection of follow-up data until Dec 31st, 2012
Supplemental Figure S2: Patient allocation and classification into Rutherford subgroups
60,221 patients identified
Main diagnosis of lower limb PAD
(ICD-10: I70.20-I70.24)
Secondary diagnosis of lower limb
PAD (ICD-10: I70.20-I70.24)
33,339 patients identified
plus
8,543 patients identified
= 41,882 patients included
Main or secondary diagnosis of
Rutherford category 6 (ICD-10: I70.24)
18,339 patients
not inlcuded
Main or secondary diagnosis of
Rutherford category 5 (ICD-10: I70.23)
Main or secondary diagnosis of
Rutherford category 4 (ICD-10: I70.22)
Main or secondary diagnosis of
Rutherford category 1-3 (ICD-10:
I70.20 or I70.21)
8,416 patients with Rutherford 6
6,916 patients with Rutherford 5
5,353 patients with Rutherford 4
21,197 patients in Rutherford 1-3
From the 60,221 patients who qualified for analysis due to a hospital admission during the mentioned period (Supplemental Figure S1), a
total of 33,339 patients had a main diagnosis of PAD and were included in the analysis. Another 8,543 patients had a related main
diagnosis (Supplemental Table S1) in combination with a secondary diagnosis of lower limb PAD and were also included. These 41,882
patients were than classified by their main or secondary diagnosis in a top-down approach in subgroups with Rutherford 6, 5, 4 or 1-3.
Reinecke et al. Outcome of PAD and CLI - Page 4
Supplemental Table S1: Diagnosis codes used for this analysis according to ICD-10
(German modification)
ICD code
Codes for qualifying
diagnoses
E10.50, E10.51
E10.74, E10.75
E11.50, E11.51
E11.72, E11.73
E11.74, E11.75
I70.2*
I70.20
I70.21
I70.22
I70.23
I70.24
I70.25
I73*
I74*
L03.01, L03.02, L03.11
L98.4
R02
Codes for secondary
diagnoses
A30-49*
B95-B99*
C*
E10*
E11*
E66*
E78*
F17*
I10-15*
I21*
I25*
I50*
I63*
I70.2*
N17*
N18*
Description
Type I diabetes with peripheral vascular complications
Type I diabetes with diabetic foot syndrome
Type II diabetes with peripheral vascular complications
Type II diabetes with multiple including vascular complications
Type II diabetes with diabetic foot syndrome
Atherosclerosis of arteries of extremities
Lower- limb: Walking distance 200 m and more
Lower limb: Exercise induced pain with walking distance < 200 m
Lower limb: rest pain
Lower limb: ulcerations
Lower limb: necrosis and gangrene
Upper limb PAD, all stages
Other peripheral vascular diseases
Arterial embolism and thrombosis
Cellulitis of finger and toe including acute lymphangitis
Chronic ulcer of skin, not elsewhere classified
Gangrene, not elsewhere classified
Other bacterial diseases including systemic inflammatory response
syndrome
Bacterial, viral and other infectious agents
Neoplasms
Type I diabetes
Type II diabetes
Obesity
Disorders of lipoprotein metabolism and other lipidaemias
Mental and behavioural disorders due to use of tobacco
Hypertensive disease
Acute myocardial infarction
Chronic ischaemic heart disease
Chronic heart failure
Cerebral infarction incl. occlusion and stenosis of cerebral and
precerebral arteries, resulting in cerebral infarction
Atherosclerosis of arteries of extremities
Acute renal failure
Chronic kidney disease
Diagnosis codes used for patients’ identification and inclusion in the analysis are printed
in the upper half of the table. Codes for analysis of secondary diagnoses, comorbidities
and complications during in-hospital stay are shown in the lower part of the Table.
Of note, the German ICD-10 catalogue is in all cases identical with the WHO ICD-10
catalogue, but provides at some points more detailed subdiagnoses and descriptions for
correct coding with the German DRG system. The * indicates that additional digits for
specific descriptions of types and locations must be added. ICD-10 indicates
International classification of Disease 10th version; PAD, peripheral arterial disease.
Supplemental Table S2: Number of Patients with qualifying main and secondary
diagnosis with regard to their ICD-10 codes
Main
diagnosis
Secondary diagnosis of PAD (ICD-10 I70.2*)
None
I70.20
I70.21
I70.22
Total, n
I70.23 I70.24
9
4
E10.50
8
2
6
3
E10.51
5
0
3
1
1
E10.74
103
5
1
1
E10.75
119
2
1
E11.50
156
21
E11.51
97
E11.72
I70.25
0
32
6
0
16
35
30
0
175
1
33
35
0
191
710
168
258
276
8
1,597
3
36
22
36
68
1
263
336
15
38
8
30
58
1
486
E11.73
3,261
95
138
43
52
42
1
3,632
E11.74
1,579
91
101
66
1,057
1,438
3
4,335
E11.75
1,068
48
50
29
446
652
2
2,295
I70.20
571
30
17
11
2
2
0
633
I70.21
15,919
128
2,140
95
26
19
18
18,345
I70.22
3,439
26
187
585
37
32
2
4,308
I70.23
3,431
30
113
45
1,025
126
4
4,774
I70.24
3,426
34
86
46
120
1,561
6
5,279
I70.25
166
6
19
1
4
4
23
223
I73.0
412
7
8
2
2
3
4
438
I73.1
91
2
9
4
4
7
0
117
I73.8
98
1
3
1
2
0
1
106
I73.9
227
9
13
4
4
7
0
264
I74.0
148
6
68
35
9
10
0
276
I74.1
30
0
1
2
1
0
0
34
I742
756
12
27
6
2
2
17
822
I74.3
1,858
84
494
502
110
185
1
3234
I74.4
51
2
4
7
3
3
0
70
I74.5
134
8
62
53
6
19
2
284
I74.8
55
1
0
0
0
0
0
56
I74.9
31
3
3
5
1
1
0
44
L03.01
1,654
1
1
1
0
1
3
1,661
L03.02
747
22
12
5
25
14
0
825
L03.11
4,014
42
45
31
49
70
0
4,251
740
18
5
6
22
7
0
798
328
9
1
1
2
16
0
357
45,058
763
4,402
1,790
3,413
4,698
97
60,221
L98.4
R02
Total, n
Patients were included in the analysis (bold cells and numbers) if they either had a main
diagnosis of lower limb PAD (I70.20 to I70.24) OR if they had one of the other main diagnoses
on the left in combination with a secondary diagnosis of lower limb PAD.
ICD-10, International classification of Disease 10th version; PAD, peripheral arterial disease.
Supplemental Table S3: Used procedure codes in accordance to the OPS classification
OPS Code
Description
3-605
Diagnostic angiography of iliac vessels
3-607
Diagnostic angiography of lower limb vessels
8-836*
Endovascular treatment (e.g. PTA, thrombolysis)
8-84*
Endovascular stenting
5-380*
Incision, embolectomy and thrombectomy
5-381*
Thrombendatherectomy
5-383*
Resection and interponats of blood vessels
5-386*
Excision of aneurysms
5-388*
Suture of vascular vessels
5-393*
Peripheral bypass grafting
5-395*
Patch operations
5-864*
Major amputations, above the ankle
5-865*
Minor amputations, below the ankle
5-866*
Revision of an amputation
All procedures and interventions have to be coded with a distinct code for type and
anatomic location of the treatment, which then is relevant for correct grouping and
reimbursement in the German DRG system. The * indicates that additional digits for
specific descriptions of types and anatomic locations can/must be added.
OPS indicates “Operationen und Prozedurenschlüssel”.
Reinecke et al. Outcome of PAD and CLI - Page 7
Supplemental Table S4: Multivariate Cox regression analyses for death during follow-up, stratified by age quintiles
Age 0-61 years
(n=8,504)
HR (95% CI)
p
Age 62-69 years
(n=8,796)
HR (95% CI)
p
1
Age 70-75 years
Age 76-82 years
Age 83-99 years
(n=8,836)
(n=8,022)
(n=7,723)
HR (95% CI)
p
1
HR (95% CI)
p
1
HR (95% CI)
p
RF 1-3
1
1
RF 4
2.00 (1.59-2.51)
<0.001
2.00 (1.67-2.37)
<0.001
1.94 (1.66-2.26)
<0.001
1.96 (1.72-2.24)
<0.001
2.06 (1.83-2.32)
<0.001
RF 5
3.31 (2.66-4.11)
<0.001
2.73 (2.34-3.17)
<0.001
2.52 (2.21-2.87)
<0.001
2.58 (2.31-2.89)
<0.001
2.29 (2.07-2.54)
<0.001
RF 6
3.87 (3.20-4.67)
<0.001
3.60 (3.13-4.13)
<0.001
3.44 (3.06-3.87)
<0.001
4.02 (3.62-4.46)
<0.001
3.55 (3.22-3.91)
<0.001
Male gender
1.24 (1.05-1.46)
0.01
1.23 (1.09-1.38)
0.001
1.25 (1.13-1.38)
<0.001
1.22 (1.13-1.32)
<0.001
1.14 (1.07-1.22)
<0.001
Hypertension
1.11 (0.95-1.29)
0.2
0.83 (0.74-0.93)
0.001
0.85 (0.77-0.94)
0.001
0.75 (0.69-0.82)
<0.001
0.84 (0.79-0.89)
<0.001
Obesity
0.93 (0.74-1.16)
0.5
0.85 (0.71-1.02)
0.08
0.92 (0.78-1.08)
0.3
0.80 (0.68-0.95)
0.011
0.74 (0.60-0.92)
0.006
Dyslipidemia
0.73 (0.61-0.87)
<0.001
0.72 (0.64-0.81)
<0.001
0.73 (0.65-0.81)
<0.001
0.80 (0.73-0.88)
<0.001
0.68 (0.62-0.74)
<0.001
Smoking
0.93 (0.77-1.11)
0.4
1.08 (0.93-1.25)
0.3
1.17 (0.98-1.40)
0.8
1.10 (0.90-1.34)
0.4
0.79 (0.61-1.04)
0.09
Diabetes
1.02 (0.87-1.21)
0.8
1.04 (0.93-1.17)
0.5
1.09 (0.99-1.20)
0.8
1.03 (0.95-1.11)
0.5
1.00 (0.93-1.07)
0.9
CAD
1.43 (1.20-1.70)
<0.001
1.42 (1.26-1.60)
<0.001
1.24 (1.12-1.37)
<0.001
1.19 (1.09-1.30)
<0.001
1.17 (1.09-1.26)
<0.001
CHF
1.93 (1.63-2.34)
<0.001
2.03 (1.75-2.35)
<0.001
1.66 (1.47-1.87)
<0.001
1.68 (1.52-1.85)
<0.001
1.48 (1.38-1.60)
<0.001
CKD
1.95 (1.63-2.34)
<0.001
1.69 (1.50-1.91)
<0.001
1.75 (1.59-1.93)
<0.001
1.61 (1.48-1.74)
<0.001
1.23 (1.15-1.31)
<0.001
Malignancies
5.26 (3.77-7.34)
<0.001
4.26 (3.39-5.36)
<0.001
2.43 (1.98-2.98)
<0.001
1.76 (1.44-2.15)
<0.001
1.53 (1.27-1.84)
<0.001
CAD indicates coronary artery disease; CHF, chronic heart failure, CKD, chronic kidney disease; CI, confidence interval; HR, hazard
ratio; MI, myocardial infarction; RF, Rutherford category.
Bold numbers indicate significant p-values. Comorbidities were defined on the basis of given ICD-10 codes, and are presented in detail in
Supplemental Table S1.
Supplemental Table S5: Multivariate Cox regression analyses for amputation during follow-up, stratified by age quintiles
Age 0-61 years
(n=8,500)
HR (95% CI)
p
Age 62-69 years
(n=8,793)
HR (95% CI)
p
1
Age 70-75 years
Age 76-82 years
Age 83-99 years
(n=8,832)
(n=8,017)
(n=7,718)
HR (95% CI)
p
1
HR (95% CI)
p
1
HR (95% CI)
p
RF 1-3
1
1
RF 4
3.13 (2.37-4.13)
<0.001
3.36 (2.60-4.35)
<0.001
2.70 (2.08-3.49)
<0.001
3.30 (2.54-4.27)
<0.001
2.15 (1.64-2.82)
<0.001
RF 5
12.2 (9.82-15.2)
<0.001
11.0 (9.03-13.49)
<0.001
9.80 (8.15-11.8)
<0.001
8.50 (6.91-10.5)
<0.001
4.67 (3.75-5.83)
<0.001
RF 6
34.0 (28.0-41.2)
<0.001
32.7 (27.3-39.2)
<0.001
28.6 (24.1-33.9)
<0.001
25.4 (20.9-30.9)
<0.001
17.5 (14.3-21.6)
<0.001
Male gender
1.27 (1.11-1.45)
<0.001
1.38 (1.22-1.56)
<0.001
1.37 (1.23-1.52)
<0.001
1.37 (1.24-1.52)
<0.001
1.28 (1.16-1.40)
<0.001
Hypertension
0.96 (0.85-1.09)
0.5
0.98 (0.87-1.10)
0.7
0.96 (0.86-1.07)
0.5
0.93 (0.84-1.04)
0.2
0.84 (0.77-0.93)
<0.001
Obesity
0.90 (0.76-1.06)
0.2
0.92 (0.78-1.08)
0.3
0.94 (0.79-1.12)
0.5
0.89 (0.72 1.10)
0.3
0.88 (0.66-1.17)
0.4
Dyslipidemia
0.88 (0.76-1.02)
0.09
0.81 (0.71-0.91)
<0.001
0.81 (0.72-0.91)
<0.001
0.86 (0.77-0.97)
0.016
0.86 (0.76-0.98)
0.02
Smoking
0.84 (0.71-0.98)
0.026
1.00 (0.84-1.18)
1.0
0.76 (0.61-0.96)
0.02
0.90 (0.67-1.21)
0.5
0.61 (0.39 0.96)
0.032
Diabetes
1.74 (1.54-1.98)
<0.001
1.65 (1.48-1.85)
<0.001
1.54 (1.39-1.71)
<0.001
1.40 (1.27-1.55)
<0.001
1.22 (1.11-1.34)
<0.001
CAD
1.06 (0.91-1.25)
0.4
0.98 (0.86-1.11)
0.7
1.03 (0.92-1.15)
0.6
0.89 (0.79-0.99)
0.039
1.05 (0.94-1.16)
0.4
CHF
1.17 (0.94-1.46)
0.2
1.10 (0.94-1.29)
0.2
1.08 (0.94-1.24)
0.3
1.22 (1.07-1.39)
0.002
1.02 (0.91-1.14)
0.7
CKD
1.17 (1.01-1.35)
0.036
1.29 (1.14-1.46)
<0.001
1.08 (0.97-1.20)
0.2
1.15 (1.04-1.28)
0.009
1.03 (0.93-1.13)
0.5
Malignancies
0.98 (0.61-1.59)
0.9
0.98 (0.69-1.39)
0.9
1.05 (0.79-1.40)
0.7
0.88 (0.64-1.21)
0.4
0.73 (0.52-1.02)
0.07
CAD indicates coronary artery disease; CHF, chronic heart failure, CKD, chronic kidney disease; CI, confidence interval; HR, hazard ratio;
MI, myocardial infarction; RF, Rutherford category.
Bold numbers indicate significant p-values. Comorbidities were defined on the basis of given ICD-10 codes, and are presented in detail in
Supplemental Table S1.