Background Gout is a common inflammatory arthropathy with a reported prevalence ranging from 1.7% to 4% within Australia – one of the highest in the world, second only to New Zealand.¹ Epidemiological studies have established that its prevalence has increased steadily over recent years, with the impact of the disease on the rise.²

Gout has painful and debilitating effects on patients leading to impact on their quality of life. Even though usually managed in the primary care setting, many patients are ultimately admitted as inpatients to hospital with the associated increased resource utilisation and cost. There is a growing recognition of the economic burden of gout.³ A Canadian study estimated 5-year total health costs of patients with gout at $10,332 more than comparable gout free patients.⁴

Objectives To identify factors potentially contributing to increased length of inpatient hospital stay for acute exacerbations of gout in a teaching hospital in Melbourne, Australia.

Methods Patients admitted to The Northern Hospital, Melbourne, Australia with a discharge diagnosis of gout as their only acute medical problem between 1st July 2014 and 30th June 2016 were identified using ICD-10 disease coding from institutional compensation reports. Retrospective chart review was performed identifying length of stay and for variables which may potentially affect it.

Results 121 patients were discharged with an acute gout flare over the 2 years with a mean age of 66±15 years. The vast majority of patients in this cohort were male (86%). The mean length of stay was 2.3 days (95% CI 1.83–2.78 days), with a median of 1 day. The median length of hospital stay was increased by 2 days if patients lived alone (p=0.042) and 1 extra day if the C-Reactive Protein (CRP) measured at admission was >100 mg/L (p=0.001). Hospital stay was similarly prolonged by a single day if more than one joint was involved in the flare (p=0.003).

Conclusions Gout without antecedent acute medical comorbidity is a common acute medical presentation to hospital with a large corresponding economic burden. Factors affecting length of inpatient stay include social status, marked elevation of CRP and polyarticular involvement. This study identifies factors which warrant further investigation as to how they may be ameliorated in order to improve health resource utilisation.

References

1. Smit E, Hoy D, Cross M et al. Burden of disability due to musculoskeletal (MSK) disorders. Ann Rheum Dis 2014; 73: 1470–1476.

2. Becker MA. Recent developments in the management of gout. Rheumatology 2012;51:i1.

3. Shields GE, Beard SM. A systematic review of the economic and humanistic burden of gout. PharmacoEconomics 2015;33: 1029–1047.

4. Fischer A, Cloutier M, Goodfield J, Borrelli R, Marvin D, Dziarmaga A. The direct economic burden of gout in an elderly Canadian population. J Rheumatol 2017;44(1):95–101.

References

Disclosure of Interest None declared