Background/Purpose: Acute gout can develop in hospitalised patients either as a new event or as a recurrence of established disease. To date there have been no studies examining the effect of in-hospital acute gout on hospital length of stay (LOS) or health resource utilisation. This study was performed to investigate the burden of gout in a hospitalised population and to assess the impact of acute gout on patient outcomes and health resource utilisation.

Methods: The study utilised hospital administrative data from The Royal Melbourne Hospital, Victoria over a ten year period (1 January 2001 to 31 December 2010).  Gout was defined according to The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) codes and subdivided into three categories: ‘P-gout’ (gout was the primary reason for admission or was a pre-existing condition requiring treatment initiation/adjustment during admission), ‘C-gout’ (gout occurred as a complication during hospitalisation and was not a pre-existing condition), or ‘A-gout’ (gout was an associated diagnosis and did not require specific treatment during admission). The overall burden of gout was measured by determining the prevalence of gout diagnoses affecting all hospital admissions (excluding day case admissions) over the study period. The effect of acute gout on patient outcomes and health resource utilisation was measured in a nested case control study with matching of ‘C-gout’ patients to controls (ratio of 1:5) by age, gender, and principal diagnosis. Outcome measures included LOS, 28-day hospital readmission rates, and total number of hospital days in the 12 months post hospital discharge. For comparisons between ‘C-gout’ and matched control cases, the student T-test or Wilcoxon ranksum test for continuous data and Chi²test for categorical data were used. A p-value of <0.05 was considered significant. 

Results: There were 278,491 multi-day hospital admission episodes during the 10 year study period. Of these, 1,400 (0.5%) had an ICD-10-AM code for gout (‘P-gout’=1,058, ‘C-gout’=307 and ‘A-gout’=35). A steady increase in the annual burden of gout of 0.22% over 10 years was noted. Patients who experienced an in-hospital attack of acute gout had a substantially longer LOS than the controls (median 13 days (IQR 7-25) vs. 5 days (IQR 2-11), p<0.001) and also had higher readmission rates in the first 28-days (p=0.002) and during the first 12 months (p<0.001) of hospital discharge.

Conclusion: Our study demonstrates a growing burden of in-hospital gout attacks and increased utilisation of health resources in patients who experience acute gout as a complication of their hospital stay. It was not possible from the design of our study to exclude other potential confounding factors which may have contributed to the observed increased hospital LOS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-prevalence-of-gout-in-a-large-tertiary-hospital-and-the-impact-of-in-hospital-attacks-of-acute-gout-on-patient-outcomes-and-health-resource-utilisation-a-nested-case-control-study/