More Surgical Patients Are Discharged against Medical Advice

Sarfraz A, Khalil M, Woldesenbet S, et al. Association of Discharge Against Medical Advice with Surgical Outcomes and Healthcare Cost. J Am Coll of Surg. 2025; in press. 

The consequences of discharge against medical advice (DAMA) have been widely studied in medical and emergency settings, but DAMA impact in the surgical setting has been previously poorly defined.

Sarfraz and colleagues, from The Ohio State University Wexner Medical Center in Columbus, evaluated DAMA trends, risk factors, and postoperative outcomes in patients 18 years and older undergoing major operations such as abdominal aortic aneurysm (AAA) repair, coronary bypass grafting (CABG), colectomy, esophagectomy, hepatectomy, pancreatectomy, and pneumonectomy. 

After reviewing more than 1.7 million surgical patient records in the Nationwide Readmissions Database for procedures between 2016 and 2020, the researchers found that DAMA increased from 17.0% in 2016 to 25.3% in 2020 and that DAMA patients had a two-fold risk for 30-day perioperative complications, resulting in additional medical expenditures of more than $21.2 million. 

Patients most likely to be associated with DAMA included those who were younger (median 61 years vs. 68 years), male (69.1%), those with a substance use disorder, and those in the lowest income quartile. DAMA rates were highest among those undergoing colectomy, CABG, and AAA repair and—notably—more likely to be treated at low-volume hospitals and private for-profit hospitals. 

The authors noted that their findings point to the need for tailored interventions, such as structured discharge planning, inpatient addiction and psychiatric services, and improved post-discharge follow-up to help mitigate preventable readmissions and optimize care.