Background/Purpose: Management of gout in the hospital setting has been poor.  This study aimed to describe patient characteristics and the treatment patterns of acute gout for patients hospitalized with gout in a tertiary care hospital.  We hypothesized that the effects of treatment for gout and diagnostic delays for those with acute gout would prolong hospital length of stay.

Methods: Medical records of patients hospitalized with a primary or secondary diagnosis of gout (ICD-9-CM: 274.9) were retrospectively reviewed from 2005-2011.  Charts were abstracted for demographic data (age, sex, race, insurance status, primary language), co-morbid conditions, length of stay, day of musculoskeletal complaint, medications used to treat gout, day of rheumatology consultation, and day of diagnosis of gout.  Bivariate analyses were performed using Fisher’s exact tests for categorical variables, and t-tests and analysis of variance for continuous variables.  Multivariable regression testing was performed to evaluate factors associated with length of stay after adjustment for age, race, sex, insurance status, Charlson comorbidity Index, diabetes, chronic kidney disease, heart disease, and history of gout. A follow up qualitative chart review was done to evaluate other factors contributing to length of stay for female and male patients.

Results: A total of 205 patients were included. 24.4% (n = 50) were females and 75.6% (n = 155) were males.  7.8% of patients were white, while 82.9% were black and 7.8% were Latino.  83.9% of patients had a prior diagnosis of gout.  Co-morbid conditions included cardiac disease (58.5%), pulmonary disease (33.2%), diabetes (45.8%), and chronic kidney disease (44.8%).  Rheumatology was consulted in 99.5% of admissions (n=204). 76.6% of patients were treated with intra-articular steroids (n = 157), 40.5% were treated with colchicine (n = 83), 37.1% were treated with systemic steroids (n = 76), and 6.8% were treated with NSAIDs (n = 14). In 45.4% of patients (n = 93), more than one treatment modality was used.  Only 31 patients experienced side effects from medications used to treat gout.  There was no significant association found between treatment side effects and length of stay.  There was a significant association found between time to diagnosis and length of stay (median length of stay for diagnosis within 24 hours of symptom onset vs. greater than 24 hours: 9 vs. 12.5 days, p=0.001), and between sex and length of stay (median length of stay for females vs. males: 14 vs. 9 days, p=0.01).  Multivariable regression of log length of stay revealed a diagnosis of gout made after 24 hours of symptom onset and female sex were each significantly associated with an increased length of stay (β-coefficient, p-value [0.49, p=0.000,  and 0.29, p=0.02, respectively]).  A follow up qualitative analysis revealed that females with longer length of stay had other medical complaints in addition to gout prolonging their length of stay.

Conclusion: In this retrospective cohort study, a later diagnosis of gouty arthritis and female sex were associated with an increased length of stay after controlling for potential confounders.  These data should guide future management of gout to reduce length of hospitalization.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-a-prolonged-hospital-length-of-stay-for-patients-with-acute-gout/