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Chronic Pancreatitis Patients Who Leave Against Medical Advice: Prevalence, Trend, and Predictors

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Abstract

Background and Aims

Leaving against medical advice (LAMA) is an unfortunate occurrence in 1–2% of all hospitalized patients and is associated with worse outcomes. While this has been investigated across multiple clinical conditions, studies on patients with chronic pancreatitis (CP) are lacking. We aimed to determine the prevalence and determinants of this event among patients with CP.

Methods

The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS), 2007–2014, was used in the study. Patients with LAMA were identified, and the temporal trend of LAMA was estimated and compared among patients with and without CP. We then extracted patients with a discharge diagnosis of CP from the recent years of HCUP-NIS (2012–2014) and described the characteristics of LAMA in these patients. Multivariate logistic regression models were used to evaluate predictors of LAMA.

Results

3.39% of patients with CP discharged against medical advice. LAMA rate in CP patients was higher and increased more steeply at quadruple the rate of those without. More likely to self-discharge were patients who were young, males, non-privately insured, or engaged in alcohol and substance abuse, likewise were those with psychosis and those admitted on a weekend or non-electively. The northeast and for-profit hospitals also had higher odds of LAMA. However, patients transferred from other healthcare facilities have reduced LAMA odds. Among all patients with CP, those with LAMA had shorter length of stay (2.74 [2.62–2.85] days vs. 5.78 [5.71–5.83] days) and lower hospitalization cost $23,271 [$22,171–$24,370] versus $45,472 [$44,381–$46,562] compared to the no-LAMA group.

Conclusion

LAMA occurs in approximately 1 in 29 patients with CP and is increasing at almost quadruple the rate of those without. Clinicians need to pay closer attention to the identified at-risk groups for ameliorative targeted interventions.

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Abbreviations

LAMA:

Leaving against medical advice

CP:

Chronic pancreatitis

LOS:

Length of stay

THC:

Total hospital cost

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Funding

Funding

No financial support was received for this study.

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Authors and Affiliations

  1. Department of Medicine, Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA

    Olalekan Akanbi, Mohanad Soliman & Praneeth Kudaravalli

  2. Department of Medicine, North Shore Medical Center, Salem, MA, USA

    Adeyinka Charles Adejumo

  3. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Adeyinka Charles Adejumo

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  1. Olalekan Akanbi
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  2. Adeyinka Charles Adejumo
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  4. Praneeth Kudaravalli
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Contributions

OA and ACA contributed equally to the study concept, design, acquisition, analysis, interpretation of data, and drafting of the manuscript. MS and PK edited the manuscript.

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Correspondence to Olalekan Akanbi.

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Akanbi, O., Adejumo, A.C., Soliman, M. et al. Chronic Pancreatitis Patients Who Leave Against Medical Advice: Prevalence, Trend, and Predictors. Dig Dis Sci 66, 424–433 (2021). https://doi.org/10.1007/s10620-020-06279-2

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