Abstract Background Systemic Sclerosis (SSc) patients may need hand surgery. Objective To develop a screening tool for rheumatologists to identify potential candidates with systemic sclerosis for hand surgery, optimizing referrals. Methods A pilot cross-sectional study from January 2015 to December 2016. Sample size: 51 participants. Inclusion criteria: ≥ 18 years old, meeting the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc and hand impairment. Data collected: age, sex, race, disease duration, SSc subtypes, vasodilator use, skin thickness, finger stiffness, presence of Digital Ulcers (DU) and/or calcinosis, presence of Raynaud's Phenomenon (RP) attacks, health status and disability, disease status, pain intensity and functional status of the hands. Data were analyzed by a multivariate logistic regression model. Results Fulfillment of surgical criteria: 68.8%. The surgical group had higher scores on the HAQ-DI (1.39 vs. 0.96, p =0.032) and CHFS (25.0 vs. 12.0, p =0.005) questionnaires, and a higher frequency of DU (91.43% vs. 18.75%, p <0.0010), calcinosis (60.0% vs. 0.0%, p <0.001), use of vasodilators (100.0% vs. 75.0%, p =0.007) and digital stiffness (28.57% vs. 0.0%, p =0.017). The presence of DU increased the chance of surgical indication by 46.2 times (ORIC 95% = 8.23 to 259.49). The statistical model showed good accuracy (86.3%, p <0.001), sensitivity (91.4%), and specificity (81.2%). Conclusion The presence of DU in SSc could be used as a screening feature for early identification and referral of potential candidates for hand surgery. (SSc surgery referrals crosssectional cross sectional 201 2016 size 5 participants 1 old RheumatologyEuropean Rheumatology European ACR/EULAR ACREULAR ACR EULAR (ACR/EULAR impairment collected age sex race duration subtypes thickness (DU andor or Raynauds Raynaud s RP (RP attacks disability hands 688 68 8 68.8% HAQDI HAQ DI 1.39 139 39 (1.3 vs 096 0 96 0.96 =0.032 0032 032 25.0 250 25 (25. 120 12 12.0 =0.005 0005 005 questionnaires 91.43% 9143 91 43 (91.43 1875 75 18.75% <0.0010, 00010 <0.0010 , 0010 <0.0010) 60.0% 600 60 (60.0 00 0.0% <0.001, 0001 <0.001 001 <0.001) 100.0% 1000 100 (100.0 750 75.0% =0.007 0007 007 28.57% 2857 28 57 (28.57 =0.017. 0017 =0.017 . 017 =0.017) 462 46 2 46. ORIC 95 823 23 8.2 259.49. 25949 259.49 259 49 259.49) 86.3%, 863 86 3 (86.3% 91.4%, 914 91.4% 4 (91.4%) 81.2%. 812 81.2% 81 (81.2%) 20 6 68.8 1.3 13 (1. 09 9 0.9 =0.03 003 03 25. (25 12. =0.00 000 91.43 (91.4 187 7 18.75 60.0 (60. 0.0 <0.00 100.0 10 (100. 75.0 28.57 285 (28.5 =0.01 01 82 8. 2594 259.4 86.3% (86.3 91.4 (91.4% 81.2 (81.2% 68. 1. (1 0. =0.0 (2 (91. 18.7 60. (60 <0.0 100. (100 75. 28.5 (28. 259. 86.3 (86. 91. 81. (81.2 ( =0. (91 18. (6 <0. (10 28. (28 86. (86 (81. =0 (9 <0 (8 (81 <