Background/Purpose: Patients who are diagnosed with scleroderma, undergo multiple hospitalizations during their lifetime. It still remains an incurable disease, however, numerous advances in its management have improved life expectancy and quality of life in affected patients. Hence, it is important to provide an updated surveillance data of this disease burden on inpatient hospitalizations, costs and mortality rate.

Methods:  The National Inpatient Sample database for adult patients with principle discharge diagnoses of Systemic Scleroderma (ICD 9- CM CODE: 710.1) from the years 1993-2013 was analyzed. Spearman’s correlation technique was applied using SAS 9.3 for Windows OS to determine statistical correlation of the number of hospital discharges, length of stay and hospital costs over time during these years.

Results: Total number of patients admitted with principle discharge diagnoses of systemic scleroderma decreased from 1910 in 1993 to 1665 in 2013(rho = 0.189, p=0.41). The mean length of stay for these patients did not show any statistically significant difference. The in- hospital mortality was noted to be significantly decreased from 9.63% in 1993 to 8.40% in 2013 (rho=0.681, p =.0007). The mean charges per hospital stay for adult systemic scleroderma patients increased from $14184 in 1993 to $86080 in 2013 (rho=.987, p <.0001). The aggregate charges (i.e. the national bill) increased from $41,517,946 in 1997 for adult systemic scleroderma patients to $143,104,818 in 2013.

Conclusion: A significant decrease was noted in hospital mortality in adult patients with systemic scleroderma. This is accompanied with major increase in cost of hospitalization during this time. This change can be attributed to increase in use of pharmacologic agents including immune-modulators and anti-fibrotic therapy, increased use of hematopoietic stem cell transplantation, advances in organ based treatment e.g. use of ACE inhibitors in scleroderma renal crisis, screening of these patients leading to early detection of complications and initiation of treatment. Also, multi-disciplinary approach to management including pulmonologists, gastroenterologists, nephrologist, dietician and social worker evaluation in hospital adds to the cost burden. A decrease in total number of admissions for adult patients with systemic scleroderma was noted. This may be attributed to better outpatient management for these patients. More data is required to study the trends in hospital admissions in these patients. Further research is required on cost effective management in patients with systemic scleroderma.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inpatient-trends-for-adults-with-scleroderma-in-the-united-states-a-20-year-analysis/