Obada Hasan - Orthopedic Section, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
Muhammad Adeel Samad - General Surgery Department, York Hospital, York, PA, USA
Hamza Khan - General Surgery Department, Yale University, New Haven, CT, USA
Maryam Sarfraz - Medical College, The Aga Khan University, Karachi, Pakistan
Shahryar Noordin - Orthopedic Section, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
Tashfeen Ahmad - Orthopedic Section, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
Gul Nowshad - Pioneer Public Health Consultants (PPHCUSA), Houston, TX, USA

Background Approximately ۱% to ۲% of hospitalized patients get discharged or leave from the hospital against medical advice and up to ۲۶% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital.   Methods Retrospective cohort study on patients admitted in all departments at our institute over a ۱-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within ۳۰ days; to clinic or emergency department was outcome variable for regression.   Results From June ۲۰۱۵ to May ۲۰۱۶ there were ۴۲۹ LAMA patients, accounting for ۰.۷% of total admissions. Females were ۲۲۳ (۵۲%) compared to males ۲۰۶ (۴۸%). Finances were quoted as the most common reason for LAMA by ۱۷۴ (۴۱%) patients followed by domestic problems ۷۸ (۱۸%). Internal medicine was the service with the highest number of LAMA patients ie, ۱۵۳ (۳۶%) followed by Pediatric medicine with ۷۳ (۱۷%). Of the ۴۲۹ patients, ۱۴۷ (۳۴%) patients revisited the hospital within ۳۰ days. Sixty-one percent of these ‘bounced-back’ LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital.   Conclusion Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and ‘bouncing back.’ This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences.

LAMA, DAMA, Morbidity, Developing Country