10.18 Pyoderma Gangrenosum: An Analysis of 2273 Cases – Demographics, Treatments and Outcomes

S. E. Sasor¹, T. Soleimani¹, R. L. Flores¹, R. Sood¹, J. Socas¹, Y. Tahiri¹, W. Wooden¹, I. A. Munshi¹, S. S. Tholpady^{1  1}Indiana University School Of Medicine,Plastic Surgery,Indianapolis, IN, USA

Introduction:
Pyoderma gangrenosum (PG) is a rare skin condition within the spectrum of neutrophilic and auto-inflammatory dermatoses. Diagnosis is difficult and treatment is often delayed due to confusion with other skin conditions, including wound infection in the surgical patient population. To date, data on this disease is limited to case series and small cohort studies. In this study, the authors characterize clinically relevant features associated with PG based on a large inpatient cohort.

Methods:
The National Inpatient Sample Database (NIS) was used to identify patients with the diagnosis of pyoderma gangrenosum over a three year period from 2008 to 2010. Data was collected on demographics, associated diagnoses, treatments and outcomes.

Results:
A total of 2273 patients were identified with PG during the study period. Mean age was 56 years. 66.3% of patients were female.  Prevalence was highest in Caucasians (71.1%), followed by black (17.6%), Hispanic (7.1%), and Asian (1.3%) races. The disease was evenly distributed across socioeconomic groups based on median household income (25%, 27%, 24.6%, and 23.6% in 1^st-4^th quartiles, respectively) and Medicare was the most common primary expected payer (48%). PG was most often treated in large (69%), urban (91.6%), teaching (54.8%) hospitals located in southern states (39%). Pyoderma gangrenosum was the primary diagnosis in 22.6% of patients. Other primary diagnoses included cellulitis (9.44%), inflammatory bowel disease (6.9%), wound/ulcer (5.4%), sepsis (4.7%), post-operative infection/complication (2.7%), and pneumonia (2.2%). The most common procedures performed on patients with PG were wound debridement (10.8%), skin biopsy (10.3%), large bowel biopsy (3.6%), incision and drainage (2.4%), EGD (1.8%) and skin grafting (1.6%). 74 patients (3.2%) died during hospitalization.

Conclusion:
Pyoderma gangrenosum is a rare but serious skin condition, most common in females and Caucasians, frequently associated with systemic disease, and often confused with other skin disorders.  PG should be considered in the differential diagnosis when evaluating patients with ulcers, wounds and post-operative complications. A heightened awareness of the disease and multi-disciplinary approach is needed for proper diagnosis and management.