Consequences and predisposing factors of self-discharge against medical advice in plastic and hand surgery

Abstract

Therapeutic success of surgical interventions is significantly affected by patients’ adherence. Patient autonomy can lead to unreasonable behavior. We analyzed the consequences and predisposing factors of patient self-discharge in a plastic and hand surgery cohort. Data was collected retrospectively in a case–control study with n\u2009=\u200973 patients who had self-discharged in a 10-year time period and n\u2009=\u2009130 controls (discharge by the surgeon). Data was collected through the hospital information systems and a particular questionnaire. Statistical analyses were performed via chi-squared test and logistic regression analyses. Patients who self-discharged against medical advice had a significantly higher complication rate (p\u2009=\u20090.045) and a higher number of revision operations (p\u2009<\u20090.001). They were more often dissatisfied with the primary inpatient treatment (p\u2009<\u20090.05). Secondly, they lived more often in shared households (p\u2009=\u20090.002; OR 5.387 (1.734–16.732)) or had to take care of their children at home (p\u2009=\u20090.006; OR 1.481 (1.280–1.741)). There was a significantly lower pain score (NAS) on time of self-discharge (p\u2009=\u20090.002) as well as 24 h after self-discharge (p\u2009<\u20090.001) in self-discharged patients. Self-discharge was associated with predisposing factors and poorer outcomes. Patient autonomy can lead to health-compromising behavior and patients should be counseled accordingly.