Columbus-based Ohio State University Wexner Medical Center and James Comprehensive Cancer Center researchers found about 1% to 2% of all inpatient hospitalizations resulted in patients discharging against medical advice — and these patients led to more than $800 million in annual associated healthcare costs.
The study, published June 26 in Journal of the American College of Surgeons, used the data from 1,768,752 surgical patients between 2016 and 2020 in the Nationwide Readmissions Database. All patients underwent major surgeries in various medical specialties. Researchers evaluated trends in DAMA incidence, postoperative outcomes, risk factors for DAMA and 30-day healthcare expenditures.
Here are five findings:
1. Of the 1.7 million surgical patients studied, 3,951, or 0.22%, were discharging against medical advice.
2. Patients who left the hospital early had a complex mix of socioeconomic factors, poor symptom management and remained in a compromised clinical state that heightened their risk of complications and mortality.
3. The number of patients who discharged against medical advice increased from 17% in 2016 to 25.3% in 2020.
4. DAMA patients had longer index hospital stays, higher hospitalization costs and increased 30-day readmission risks.
5. The patients most likely to discharge against medical advice were male, younger in age and had substance use disorders.
