Background/Purpose: Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disease that results in hospitalizations in different hospital settings. It is unclear if outcomes of SSc hospitalizations differ between teaching and non-teaching hospitals. This study aims to compare outcomes of SSc hospitalizations between teaching and nonteaching hospitals.

Methods: Data were abstracted from the National Inpatient Sample (NIS) Database. NIS is the largest inpatient admission database in the United States. It is a nationally representative sample of 20% of hospitalizations from approximately 1000 hospitals.  The numbers in the databases are weighted to optimize national estimates. The NIS was searched for SSc hospitalizations in 2016 using ICD-10 code “M34” as the principal or secondary diagnosis. Only hospitalizations for patients aged ≥ 18 years were included. The primary outcome was inpatient mortality. Multivariate logistic regression analysis was used to adjust for confounders for the primary outcome. Secondary outcomes were hospital length of stay (LOS) and total hospital charges. Multivariate linear regression analysis was used to adjust for confounders for the secondary outcomes. Confounders adjusted for include age, sex, race, median income expected for zip code, Charleston comorbidity index, insurance status, hospital location/region, and bed size. STATA software was used to analyze the data.

Results: There were over 35 million discharges included in the 2016 NIS database. 30,965 hospitalizations were for patients aged ≥18 years, who had either a principal or secondary ICD 10 code for SSc. 22,280 of these hospitalizations (72%) were in teaching hospitals, while 8,685 hospitalizations (28%) were in nonteaching hospitals. The mean age for teaching hospital hospitalizations was 61.45 vs 64.56 for nonteaching hospitals (P< 0.0001). 1,395 (4.5%) hospitalizations resulted in inpatient mortality. Inpatient mortality occurred in 4.7% of hospitalizations in teaching hospitals vs 4.1 % in nonteaching hospitals (P=0.3164). The adjusted odds ratio (AOR) of inpatient mortality in teaching hospitals compared to nonteaching hospitals was 1.05 (95% CI 0.78-1.42, P=0.75). Mean LOS for hospitalizations in teaching hospitals was 6.67 vs 5.18 days for nonteaching hospitals. Hospitalizations in teaching hospitals have a mean increase in Adjusted LOS of 1.12 days (95% CI 0.69-1.54, P< 0.0001) compared to nonteaching hospitals. Total hospital charges for hospitalizations in teaching hospital was $75,943.58 vs $51,611.54 for nonteaching hospitals. Hospitalizations in teaching hospitals have an increase in adjusted total hospital charges of $16,333 compared to nonteaching hospitals (95% CI 9,005-23,660, P< 0.0001).

Conclusion: There was no statistically significant difference in inpatient mortality for SSc hospitalizations in teaching compared to nonteaching hospitals. SSc hospitalizations in teaching hospitals had younger patients, more LOS, and total hospital charges compared to nonteaching hospitals.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-of-systemic-sclerosis-hospitalizations-by-hospital-teaching-status-analysis-of-the-national-inpatient-sample/