The following is a summary of “Discharge Against Medical Advice After Hospitalization for Sepsis: Predictors, 30-Day Readmissions, and Outcomes,” published in the November 2023  issue of Emergency Medicine by Ni, et al.

Sepsis is the main reason people die around the world. However, not much is known about the state of release against medical advice (DAMA) in people with sepsis. For a study, researchers sought out what factors were linked to DAMA and looked at the link between DAMA and 30-day unexpected readmission and readmission results after sepsis treatment. 

They used the National Readmission Database to find sepsis patients discharged normally or on DAMA in 2017. Multivariable models were used to find factors connected to DAMA, study the link between DAMA and readmission, and determine how DAMA affected results in patients readmitted within 30 days. 

Out of the 1,012,650 people who got sepsis, 3,88% (n = 39,308) had DAMA. The rates of unscheduled return after 30 days were 13.08% for patients sent home and 27.21% for those sent to DAMA. Medicaid, diabetes, smoking, drug and alcohol abuse, and psychoses were all linked to DAMA in sepsis. There was a statistically significant link between DAMA and readmissions within 30 days (OR = 2.18; 95% CI = 2.09–2.28), 60 days (OR = 1.98; 95% CI = 1.90–2.06), and 90 days (OR = 1.88; 95% CI = 1.81–1.96). 

DAMA is also linked to a higher risk of death in patients who are readmitted within 30 days (OR 1.38, 95% CI 1.17–1.63). However, there were no statistically significant changes in length of stay or costs between patients sent home or to DAMA. DAMA happens in about 3.88% of people with sepsis and is linked to more hospital readmissions and death. People who are at a high risk of DAMA should be found early on so that they can be helped so that they don’t get released too soon and have bad results.

Source: sciencedirect.com/science/article/abs/pii/S0736467923003116