Surgical discharge against medical advice on the rise

Editor's Note

The incidence of surgical patients being discharged against medical advice is increasing, leading to a subsequent rise in postoperative complications and readmissions, according to new published research. The investigators evaluated trends, risk factors, and postoperative outcomes among surgical patients who were discharged against medical advice and their findings were published in the November issue of the Journal of the American College of Surgeons.

Data on adult patients undergoing major operations tracked between 2016 to 2020 from the Nationwide Readmissions Database were used in the study. The investigators specifically noted trends in the incidence of discharge against medical advice incidence, as well as how this discharge trend influenced postoperative outcomes and 30-day healthcare expenditures. Their findings demonstrated that among 1,768,752 surgical patients, 3,951 were discharged against medical advice. Several patient characteristics trended for this discharge against medical advice, including male sex, younger age, and substance use disorder. Among these patients, longer hospital stays of 9.85 days compared to 8.08 days were noted. Associated healthcare costs were $43,379 compared to $39,872, and 30-day readmission risk increased slightly. Discharge against medical advice was also linked to fragmented care, per the reported research findings.

The authors concluded that the rising incidence of surgical patients being discharged against medical advice and the associated costs demonstrate a need for targeted interventions. These should include risk stratification, and improved discharge planning in efforts to reduce the rate of preventable readmissions for surgical patients and improve resource utilization.