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Research News

Patients Discharged Against Medical Advice Impact Their Own Outcomes and the Health Care System

July 7, 2025

CHICAGO — Around 1-2% of all inpatient hospitalizations result in the patient being discharged against medical advice (DAMA), leading to over $800 million in annual associated health care costs.* To further understand the impact of DAMA, researchers evaluated trends including risk factors, length of stay, and readmission risk, among others. Their findings are published in the Journal of the American College of Surgeons. 

The authors report that patients who have left the hospital prematurely not only have a complex mix of socioeconomic factors, dissatisfaction with care, and poor symptom management, but also often remain in a compromised clinical state which heightens their risk of complications and mortality.

The research team, from the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, in Columbus, Ohio, used the Nationwide Readmissions Database (2016-2020). After identifying adult patients (≥18 years) undergoing major surgery in various medical specialties, including emergency departments and psychiatric units, they evaluated trends in DAMA incidence over time as well as assessed postoperative outcomes, identified risk factors for DAMA, and also compared 30-day health care expenditures.

Study Results

Among 1,768,752 surgical patients:

  • 3,951 (0.22%) were DAMA
  • Rate of DAMA increased from 17% in 2016 to 25.3% in 2020
  • Male sex, younger age, and substance use disorder were associated with DAMA
  • DAMA patients had longer index hospital stays, higher hospitalization costs, and increased 30-day readmission risk

The study’s authors concluded that with the rising incidence and costs of DAMA, there is a need for targeted interventions, including risk stratification and improved discharge planning, to reduce preventable readmissions and better use of hospital resources.

Citation: Sarfraz A, Khalil M, Woldesenbet S, et al. Association of Discharge Against Medical Advice with Surgical Outcomes and Healthcare Cost. Journal of the American College of Surgeons, 2025. DOI: 10.1097/XCS.0000000000001469

*See study references 1-2. 

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons.

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