Impacts and Risk Factors of Self-Discharge in Plastic and Hand Surgery
Overview
This study identified an increasing trend of self-discharge against medical advice in plastic and hand surgery patients, with a self-discharge rate rising from 2.6% to 4.7% over 10 years. Patients who self-discharged had significantly higher complication and reoperation rates compared to those discharged by surgeons.
Background
Patient compliance is crucial for successful surgical outcomes, with the World Health Organization defining compliance as alignment with healthcare recommendations. The shift from paternalistic to shared decision-making models aims to improve adherence, but patient autonomy can sometimes lead to self-discharge against medical advice. Understanding the factors and consequences of self-discharge is essential to optimize patient care in plastic, aesthetic, hand, and reconstructive surgery.
Data Highlights
Parameter
Self-Discharge Group
Control Group
p-value
Self-discharge rate over 10 years
2.6% to 4.7%
Lower rates in other disciplines
Not specified
Living in shared household
84.9%
67.7%
0.002
Patients with children at home
28.8%
23.1%
0.006
Pain score at discharge (NAS)
1.8/10
2.7/10
0.002
Pain score 24h post-discharge
1.7/10
2.7/10
<0.001
Self-reported complication rate
19.2%
10.0%
0.045
Revision operation rate
17.8%
3.1%
<0.001
Patient satisfaction with treatment
87.7%
95.4%
0.044
Key Findings
The proportion of patients self-discharging against medical advice increased from 2.6% to 4.7% over a decade.
Living in a shared household and having children at home were significant predictors of self-discharge (OR 5.387 and OR 1.481 respectively).
Self-discharged patients reported significantly lower pain scores at discharge and 24 hours after compared to controls.
Self-discharge was associated with a doubled risk of complications (19.2% vs. 10.0%) and a significantly higher revision surgery rate (17.8% vs. 3.1%).
Despite self-discharge, 87.7% of patients were satisfied with their medical treatment, though this was lower than the 95.4% satisfaction in the control group.
Post-discharge treatment continuation by the outpatient clinic was more frequent in the self-discharge group (27.4% vs. 10.0%).
Clinical Implications
Clinicians should recognize that patients living in shared households or with childcare responsibilities are at higher risk for self-discharge and may benefit from targeted counseling and support. Awareness of the increased complication and reoperation rates following self-discharge underscores the need for enhanced follow-up strategies. Pain levels alone may not predict self-discharge, so comprehensive assessment of social factors is essential.
Conclusion
Self-discharge against medical advice in plastic and hand surgery is rising and linked to higher complication and reoperation rates. Addressing social determinants and improving patient engagement may reduce self-discharge and improve outcomes.
References
WHO 2003 -- Adherence to Long-Term Therapies: Evidence for Action
Other authors 2011 -- Increased readmission rates after self-discharge
by Sören Könneker, Rosalia Luketina, Stefaniya Bozadzhieva, Thomas von Lengerke, Nicco Krezdorn, Theodore L. H. Luketina, Peter M. Vogt, Alexander Kaltenborn
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