Clinical Scorecard: Impacts and risk factors associated with self-discharge against medical advice in plastic and hand surgical procedures
At a Glance
Category
Detail
Condition
Self-discharge against medical advice in plastic, aesthetic, hand, and reconstructive surgery
Key Mechanisms
Patient autonomy leading to self-discharge; associated with increased complication and reoperation rates
Target Population
Adult patients undergoing plastic, aesthetic, hand, and reconstructive surgical procedures
Care Setting
Inpatient surgical care in a single-center hospital setting
Key Highlights
Self-discharge rate increased from 2.6% to 4.7% over 10 years in the studied clinic.
Patients self-discharging had significantly higher complication (19.2% vs. 10.0%) and revision operation rates (17.8% vs. 3.1%) compared to controls.
Living in shared households and having children were significant predictors of self-discharge.
Guideline-Based Recommendations
Diagnosis
Identify patients at risk of self-discharge by assessing household composition and caregiving responsibilities.
Management
Enhance physician–patient communication using shared decision-making models to improve adherence.
Provide continued outpatient follow-up, especially for patients who self-discharge.
Monitoring & Follow-up
Monitor for complications and need for reoperations more closely in patients who self-discharge.
Follow-up via general practitioners, other surgeons, or outpatient clinics to ensure continuity of care.
Risks
Self-discharge is associated with increased risk of complications and higher rates of reoperation.
Lower pain scores at discharge do not preclude risk of adverse outcomes.
Patient & Prescribing Data
Adult surgical patients in plastic and hand surgery who self-discharge against medical advice
Self-discharge patients often continue treatment with general practitioners or outpatient clinics but have higher complication and revision rates despite high satisfaction with care.
Clinical Best Practices
Implement shared decision-making to balance patient autonomy with medical recommendations.
Identify social factors such as living situation and childcare responsibilities that may predispose to self-discharge.
Ensure structured follow-up plans for patients who self-discharge to reduce complications.
Educate patients on risks associated with early discharge despite low pain scores.
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