title: Intestinal pseudo-obstruction in patients with systemic sclerosis: an analysis of the Nationwide Inpatient Sample.
abstract: OBJECTIVE
  Intestinal pseudo-obstruction is a rare gastrointestinal complication in patients with SSc without large studies examining its prevalence or outcomes. We aimed to compare outcomes in SSc patients with intestinal pseudo-obstruction to patients with intestinal pseudo-obstruction secondary to other causes, and SSc patients without intestinal pseudo-obstruction.
  
  
  METHODS
  This is a case-control study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the period 2002-2011. We included patients with the previously validated International Classification of Diseases-Clinical Modification-9 code 710.1 for SSc in combination with codes for intestinal pseudo-obstruction, and determined length of hospitalization and the risks for surgical procedures, use of total parenteral nutrition (TPN) and in-hospital mortality.
  
  
  RESULTS
  A total of 193 610 SSc hospitalizations occurred in the USA between 2002 and 2011, of which 5.4% (n = 10 386) were associated with a concurrent intestinal pseudo-obstruction diagnosis (cases). In-hospital mortality was 7.3%. In multivariate analyses, cases were more likely to die during the inpatient stay and to receive TPN than patients with idiopathic intestinal pseudo-obstruction (control group 1), patients with intestinal pseudo-obstruction and diabetes (control group 2), and SSc patients without intestinal pseudo-obstruction (control group 3). Cases had longer in-hospital stay than control groups 2 and 3, and were less likely to undergo surgical procedures than control groups 1 and 2.
  
  
  CONCLUSIONS
  Intestinal pseudo-obstruction is a rare cause of hospitalization in patients with SSc, but is associated with high in-hospital mortality in comparison with other SSc patients and those with intestinal pseudo-obstruction secondary to other causes.
authors.affiliation: Division of Immunology and Rheumatology.
authors.forename: Antonia
authors.initials: A
authors.lastname: Valenzuela
authors.affiliation: Department of Dermatology and Urology.
authors.forename: Shufeng
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA and.
authors.forename: Laren
authors.initials: L
authors.lastname: Becker
authors.affiliation: Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA and.
authors.forename: Nielsen
authors.initials: N
authors.lastname: Fernandez-Becker
authors.affiliation: Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
authors.affiliation: Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA and.
authors.forename: Linda
authors.initials: L
authors.lastname: Nguyen
authors.affiliation: Division of Immunology and Rheumatology, shauwei@stanford.edu.
authors.forename: Lorinda
authors.initials: L
authors.lastname: Chung
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D015995:Prevalence; D012595:Scleroderma, Systemic / Q000150:complications* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: ICD-9 code; Nationwide Inpatient Sample; hospitalization; intestinal pseudo-obstruction; mortality; systemic sclerosis; total parenteral nutrition