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The inpatient burden and comorbidities of pyoderma gangrenosum in adults in the United States

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Abstract

Hospital admission is often necessary for management of pyoderma gangrenosum (PG), including wound care and pain control. No large-scale controlled studies examined the burden of hospitalization for PG. The objective of this study is to determine the prevalence, predictors, outcomes, and costs of hospitalization for PG in United States adults. Data were analyzed from the 2002 to 2012 National Inpatient Sample, including a 20% representative sample of United States hospitalizations. The prevalence of hospitalization for PG increased between 2002 and 2012. Primary admission for PG was associated with age 40–59 years, female sex, black race/ethnicity, second-quartile household income, public or no insurance, and multiple chronic conditions. PG admissions were more likely at teaching and medium or large hospitals. Geometric-mean length and cost of hospitalization were higher in inpatients with vs. without a primary diagnosis of PG. The majority of inpatients with PG were classified with minor (64.4%) or moderate (25.7%) likelihood of dying, but moderate (52.5%) and major (28.7%) loss of function. PG was associated with numerous other health disorders. The limitation of this study is the lack of data on PG treatment. This study demonstrated a substantial and increasing inpatient burden of PG in the United States, with considerable disability and mortality risk, multiple comorbid health disorders, and costs.

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Abbreviations

ICD-9-CM:

International Classification of Disease 9th edition Clinical Modification

IBD:

Inflammatory bowel disease

PG:

Pyoderma gangrenosum

AIDS:

Acquired immunodeficiency syndrome

PUD:

Peptic ulcer disease

DM:

Diabetes mellitus

HS:

Hidradenitis suppurativa

NIS:

Nationwide inpatient sample

CI:

Confidence interval

CCI:

Charlson comorbidity index

HCUP:

Healthcare cost and utilization project

AHRQ:

Agency for healthcare research and quality

LOS:

Length of stay

APRDRG:

All Patient Refined Diagnosis-Related Group

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Funding

This publication was made possible with support from the Agency for Healthcare Research and Quality, grant number K12 HS023011, the Dermatology Foundation.

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Authors and Affiliations

  1. Department of Dermatology, Henry Ford Hospital, Detroit, MI, 48202, USA

    Shanthi Narla

  2. Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Avenue, Washington, DC, 20037, USA

    Jonathan I. Silverberg

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  1. Shanthi Narla
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Contributions

JIS had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: JIS. Acquisition of Data: JIS and SN. Analysis and interpretation of data: SN and JIS. Drafting of the manuscript: SN and JIS. Critical revision of the manuscript for important intellectual content: SN and JIS. Statistical analysis: JIS and SN. Obtained funding: JIS.

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Correspondence to Jonathan I. Silverberg.

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Narla, S., Silverberg, J.I. The inpatient burden and comorbidities of pyoderma gangrenosum in adults in the United States. Arch Dermatol Res 313, 245–253 (2021). https://doi.org/10.1007/s00403-020-02098-7

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  • DOI: https://doi.org/10.1007/s00403-020-02098-7

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