Discharge Against Medical Advice After Hospitalization for Sepsis: Predictors, 30-Day Readmissions, and Outcomes

Juan Ni; Zhen Lin; Qiqi Wu; Guannan Wu; Chen Chen; Binhai Pan; Beilei Zhao; Hedong Han; Qin Wang

doi:10.1016/j.jemermed.2023.05.014

Discharge Against Medical Advice After Hospitalization for Sepsis: Predictors, 30-Day Readmissions, and Outcomes

J Emerg Med. 2023 Nov;65(5):e383-e392. doi: 10.1016/j.jemermed.2023.05.014. Epub 2023 Jun 17.

Authors

Juan Ni¹, Zhen Lin², Qiqi Wu³, Guannan Wu¹, Chen Chen¹, Binhai Pan¹, Beilei Zhao¹, Hedong Han⁴, Qin Wang⁵

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
² Department of Health Statistics, Second Military Medical University, Shanghai, China; Department of Disease Control and Prevention, Xiamen University Affiliated to Chenggong Hospital, Fujian, China.
³ Department of Endocrinology, Liaoning University of Traditional Chinese Medicine, Shenyang, China.
⁴ Department of Respiratory and Critical Care Medicine, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Department of Health Statistics, Second Military Medical University, Shanghai, China.
⁵ Department of Respiratory and Critical Care Medicine, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China. Electronic address: wq.026@163.com.

PMID: 37741736
DOI: 10.1016/j.jemermed.2023.05.014

Abstract

Background: Sepsis is a leading cause of death worldwide. However, little has been known concerning the status of discharge against medical advice (DAMA) in sepsis patients.

Objective: To identify factors associated with DAMA, evaluate the association of DAMA with 30-day unplanned readmission and readmitted outcomes after sepsis hospitalization.

Methods: Using the National Readmission Database, we identified sepsis patients who discharged routinely or DAMA in 2017. Multivariable models were used to identify factors related to DAMA, evaluate the association between DAMA and readmission, and elucidate the relationship between DAMA and outcomes in patients readmitted within 30 days.

Results: Among 1,012,650 sepsis cases, patients with DAMA accounted for 3.88% (n = 39,308). The unplanned 30-day readmission rates in patients who discharged home and DAMA were 13.08% and 27.21%, respectively. Predictors of DAMA in sepsis included Medicaid, diabetes, smoking, drug abuse, alcohol abuse, and psychoses. DAMA was statistically significantly associated with 30-day (odds ratio [OR] 2.18, 95% confidence interval [CI] 2.09-2.28), 60-day (OR 1.98, 95% CI 1.90-2.06), and 90-day (OR 1.88, 95% CI 1.81-1.96) readmission. DAMA is also associated with higher mortality in patients readmitted within 30 days (OR 1.38, 95% CI 1.17-1.63), whereas there were no statistically significant differences in length of stay and costs between patients who discharged home or DAMA.

Conclusions: DAMA occurs in nearly 3.88% of sepsis patients and is linked to higher readmission and mortality. Those at high risk of DAMA should be early identified to motivate intervention to avoid premature discharges and associated adverse outcomes.

Keywords: discharge against medical advice; outcome; readmission; sepsis.