Temporal Trends and Predictors of Pancreatitis Patients Who Leave Against Medical Advice: A Nationwide Analysis

Abstract

Background: Acute pancreatitis is the leading gastrointestinal cause of hospital admissions. Our study aims to determine the trends and predictors of discharge against medical advice (AMA). Methods: We utilized the Nationwide Inpatient Sample (2003-2016) to identify patients admitted with pancreatitis. We compared in-hospital complications and determined predictors of discharge AMA using a multivariate logistic regression. Results: A total of 7,158,894 patients were admitted with pancreatitis. Of those, 199,351 left AMA. Discharge AMA increased over time from 2.3% to 3.2%. Patients who left AMA were more likely to be younger, male, black, and a lower socioeconomic status (SES). They had a greater prevalence of depression, cirrhosis, smoking, drug abuse, and human immunodeficiency virus (HIV) infection. Alcohol use was the most likely etiology of pancreatitis among those leaving AMA. In a multivariate regression, patients more likely to leave AMA included: age 18-44, male, and black. Patients with a history of depression, drug abuse, and HIV infection were also more likely to be discharged AMA. Conclusions: Discharges AMA increased over time. Predictors of AMA include patients who are younger, male, black, lower socioeconomic status, and have a history of depression, HIV infection, alcohol and drug use. Future studies are necessary to examine the reasons for discharge AMA among this population.

Rates and predictors of 30‐day hospital readmissions in adults for drug‐induced acute pancreatitis: A retrospective study from the United States National Readmission Database

“…7,16 Because several acute and chronic medical conditions are frequently associated with high readmission rates [17][18][19] and increasing healthcare economic burden and morbidity and mortality in the United States, [20][21][22] there is a growing emphasis throughout the health sector on identifying predictors of readmission to help reduce healthcare utilization and costs. [23][24][25] For instance, AP, a common gastrointestinal diagnosis in inpatient hospitalization, [26][27][28] accounts for approximately 275 000 hospitalizations annually, 29,30 with a total healthcare cost of $2.6 billion per year 29,31 and has a 30-day readmission rate as high as 13.5%. 28 Therefore, it is imperative to note that DIAP, through initial admissions, readmissions, an extensive workup to exclude other causes of AP, and hospital stay cost, can significantly contribute to the economic burden on US health systems.…”

Outcomes of Acute Pancreatitis in Hospitalized Patients With Generalized Anxiety Disorder

“…Hospitalization costs for AP are often more than $30,000 per hospitalization [3][4][5]. Over 200,000 adults per year are hospitalized due to AP, and the diagnosis of AP carries a mortality rate of around 1-2% [6,7].…”