Background/Purpose: Inadequately treated patients with chronic gout are at risk for an acute attack and many often require hospitalization. An acute attack of gout increases health care costs by an average of $6000 per day. This study was conducted with two main objectives :(1) to assess whether inadequately treated gout or non-compliance with urate lowering therapy (ULT) was responsible for primary gout admission and (2) to determine whether admissions complicated by acute gout resulted in increased in-patient length of stay and how it impacts health care cost.

Methods: Data was collected for adult patients admitted between January 2010 and December 2014 at The Brooklyn Hospital Center with either a primary or secondary discharge diagnosis of Acute Gout using ICD 9 codes. Patient data included demographics, diagnoses, length of stay, gout medications. Patients were placed into two groups: Group A included persons whose primary admitting diagnosis was acute gout and Group B consisted of patients who had gout coded as an active secondary diagnosis. Group B subjects were compared with a matched cohort of 121 subjects with gout whose admission was not complicated by acute gout during the current hospitalization period of January 2010 to December 2014.

Results: 182 subjects were studied, 97(53.3%) were in group A and 85(46.7%) were in group B. 67.0% of the subjects were male with mean age of 64.80, SD +/-12.87 years. 86.3% of the subjects were African Americans. Primary admission diagnosis for Group B subjects were stroke 1.7%, Chest pain 6.0%, acute CHF 8.8%, GI Bleed 3.3%, and other diagnoses 26.9%. Only 37% of Group A subjects were on prior ULT, excluding 8 newly diagnosed cases of gout, with RR: 0.49 (95% CI, 0.37, 0.61). The mean length of stay for Group A subjects was 5.2 days and for Group B it was 8.6 days. The mean length of stay for the matched cohorts was 4.4 days. All data were adjusted for age, gender and race. Centers of Medicare & Medicaid Services, (CMS) reimbursement of primary admission diagnosis for Group B ranged from $8630 to $7900. An additional diagnosis of acute gout did not change the Diagnosis Related Groups (DRGs) resulting in no additional CMS reimbursement. CMS reimbursed $8448 per a primary acute gout admission, a sum of $819,456 for the 5years period.

Conclusion:  Inadequately treated chronic gout was the main reason for primary gout admission at the Brooklyn Hospital Center between January 2010 to December 2014.The length of stay for patients whose primary admission was complicated by acute gout was nearly doubled when compared with patients admitted with a similar primary diagnosis. Increase length of stay did not result in a corresponding increase in CMS reimbursement. This study identified the magnitude and the cost associated with primary gout admissions and emphasized the need for initiation of ULT and adequate control of uric-acid levels as per the ACR 2012 guidelines, by primary care physicians in the outpatient setting in conjunction with a rheumatologist.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inadequately-treated-chronic-gout-as-the-main-reason-for-primary-gout-admission-in-an-urban-adult-population-results-of-a-retrospective-cohort-study/