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. 2023 May;38(7):1615-1622.
doi: 10.1007/s11606-022-07879-6. Epub 2022 Nov 7.

The Impact of Discharge Against Medical Advice on Readmission After Opioid Use Disorder-Associated Infective Endocarditis: a National Cohort Study

Asher J Schranz  1 , Casey Tak  2 , Li-Tzy Wu  3   4 , Vivian H Chu  4 , David A Wohl  5 , David L Rosen  5
Affiliations

The Impact of Discharge Against Medical Advice on Readmission After Opioid Use Disorder-Associated Infective Endocarditis: a National Cohort Study

Asher J Schranz et al. J Gen Intern Med. 2023 May.

Abstract

Background: Hospitalizations for infective endocarditis (IE) associated with opioid use disorder (O-IE) have increased in the USA and have been linked to high rates of discharge against medical advice (DAMA). DAMA represents a truncation of care for a severe infection, yet patient outcomes after DAMA are unknown.

Objective: This study aimed to assess readmissions following O-IE and quantify the impact of DAMA on outcomes.

Design: A retrospective study of a nationally representative dataset of persons' inpatient discharges in the USA in 2016 PARTICIPANTS: A total of 6018 weighted persons were discharged for O-IE, stratified by DAMA vs. other discharge statuses. Of these, 1331 (22%) were DAMA.

Main measures: The primary outcome of interest was 30-day readmission rates, stratified by discharge type. We also examined the total number of hospitalizations during the year and estimated the effect of DAMA on readmission.

Key results: Compared with non-DAMA, those experiencing DAMA were more commonly female, resided in metropolitan areas, lower income, and uninsured. Crude 30-day readmission following DAMA was 50%, compared with 21% for other discharge types. DAMA was strongly associated with readmission in an adjusted logistic regression model (OR 3.72, CI 3.02-4.60). Persons experiencing DAMA more commonly had ≥2 more hospitalizations during the period (31% vs. 18%, p<0.01), and were less frequently readmitted at the same hospital (49% vs 64%, p<0.01).

Conclusions: DAMA occurs in nearly a quarter of patients hospitalized for O-IE and is strongly associated with short-term readmission. Interventions to address the root causes of premature discharges will enhance O-IE care, reduce hospitalizations and improve outcomes.

Keywords: cardiac surgery; infective endocarditis; injection drug use; opioids; outcomes.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Time to first readmission following opioid use disorder-associated infective endocarditis. Figure legend: Cumulative all-cause readmissions following inpatient discharge for a hospitalization for opioid use disorder-associated infective endocarditis. Data is drawn from the 2016 National Readmissions Database (Agency for Healthcare Research and Quality). Shaded areas represent 95% Hall-Wellner bands.
See this image and copyright information in PMC

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