Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 13, Number 2, April 2020, pages 58-65

Temporal Trends and Predictors of Pancreatitis Patients Who Leave Against Medical Advice: A Nationwide Analysis

Figure 1. Trends of discharge AMA in patient admitted with acute pancreatitis (2003 - 2016). AMA: against medical advice.

**Table 1.** Baseline Characteristics of the Study Population
Baseline characteristics	AMA	No AMA	P value
AMA: against medical advice; N: number; SD: standard deviation; LOS: length of stay.
Patient characteristics
Age range			< 0.001
18 - 44	49.4%	32.2%
45 - 64	44.8%	40.7%
> 65	5.8%	27.1%
Male	68.2%	50.2%	< 0.001
Income			< 0.001
0 - 25th percentile	38.6%	32.2%
26th - 50th percentile	26.6%	26.4%
51th - 75th percentile	20.1%	23.0%
76th - 100th percentile	14.7%	18.4%
Race			< 0.001
White	58.4%	64.7%
Black	24.4%	17.5%
Hispanic	11.9%	12.2%
Payer			< 0.001
Medicare	21.2%	36.0%
Medicaid	32.6%	18.3%
Private insurance	17.6%	31.0%
Self-pay/no charge/other	28.6%	14.7%
Hospital characteristics
Weekend admission	26.8%	24.8%	< 0.001
Bed-size			< 0.001
Small	15.4%	14.8%
Medium	30.0%	26.6%
Large	54.6%	58.6%
Urban	75.3%	72.8%	< 0.001
Rural	24.7%	27.2%	< 0.001
LOS (median (25%, 75%))	2 (1, 3)	4 (3, 7)	< 0.001
Cost (mean ± SD ($ in dollars))	21,090 (34,274)	43,556 (88,764)	< 0.001
Cost (median (25%, 75%) ($ in dollars))	13,329,578 (7,588, 23,354)	22,419 (12,205, 43,448)	< 0.001

Table 1. Baseline Characteristics of the Study Population

Baseline characteristics

AMA

No AMA

P value

AMA: against medical advice; N: number; SD: standard deviation; LOS: length of stay.

Patient characteristics

Age range

< 0.001

18 - 44

49.4%

32.2%

45 - 64

44.8%

40.7%

> 65

5.8%

27.1%

Male

68.2%

50.2%

< 0.001

Income

< 0.001

0 - 25th percentile

38.6%

32.2%

26th - 50th percentile

26.6%

26.4%

51th - 75th percentile

20.1%

23.0%

76th - 100th percentile

14.7%

18.4%

Race

< 0.001

White

58.4%

64.7%

Black

24.4%

17.5%

Hispanic

11.9%

12.2%

Payer

< 0.001

Medicare

21.2%

36.0%

Medicaid

32.6%

18.3%

Private insurance

17.6%

31.0%

Self-pay/no charge/other

28.6%

14.7%

Hospital characteristics

Weekend admission

26.8%

24.8%

< 0.001

Bed-size

< 0.001

Small

15.4%

14.8%

Medium

30.0%

26.6%

Large

54.6%

58.6%

Urban

75.3%

72.8%

< 0.001

Rural

24.7%

27.2%

< 0.001

LOS (median (25%, 75%))

2 (1, 3)

4 (3, 7)

< 0.001

Cost (mean ± SD ($ in dollars))

21,090 (34,274)

43,556 (88,764)

< 0.001

Cost (median (25%, 75%) ($ in dollars))

13,329,578 (7,588, 23,354)

22,419 (12,205, 43,448)

< 0.001

**Table 2.** Patient Comorbidities, Complications and Interventions
Comorbidities, complications and interventions	AMA	No AMA	P value
AMA: against medical advice; COPD: chronic obstructive pulmonary disease; HIV: human immunodeficiency virus; EGD: esophagogastroduodenoscopy; ERCP: endoscopic retrograde cholangiopancreatography.
Comorbidities
Diabetes mellitus	20.6%	26.3%	< 0.001
Hypertension	40.6%	48.4%	< 0.001
Dyslipidemia	13.7%	24.1%	< 0.001
Coronary artery disease	6.8%	12.0%	< 0.001
Peripheral vascular disease	2.1%	4.1%	< 0.001
Atrial fibrillation/flutter	2.1%	6.2%	< 0.001
Inflammatory bowel disease	1.0%	1.4%	< 0.001
Liver cirrhosis	10.9%	8.6%	< 0.001
Chronic kidney disease	5.7%	8.7%	< 0.001
Anemia	17.6%	21.8%	< 0.001
COPD	13.6%	14.6%	< 0.001
Smoking	44.4%	22.6%	< 0.001
Drug abuse	18.4%	6.8%	< 0.001
Depression/psychosis	10.6%	7.1%	< 0.001
HIV infection	3.0%	1.4%	< 0.001
Alcohol	52.3%	23.5%	< 0.001
Biliary pancreatitis	9.5%	22.3%	< 0.001
Other cause of pancreatitis	16.0%	26.6%	< 0.001
Complications
Acute kidney injury	7.3%	12.0%	< 0.001
Respiratory failure	1.8%	5.0%	< 0.001
Sepsis	0.5%	2.1%	< 0.001
Urinary tract infection	0.4%	0.7%	< 0.001
Gastrointestinal bleeding	4.1%	3.0%	< 0.001
Interventions
ERCP	1.8%	9.7%	< 0.001
Endoscopy	4.9%	9.8%	< 0.001
EGD	4.7%	9.0%	< 0.001
Colonoscopy	0.8%	2.1%	< 0.001
Acute kidney injury requiring hemodialysis	1.4%	2.6%	< 0.001
Blood transfusion	3.0%	6.0%	< 0.001

Table 2. Patient Comorbidities, Complications and Interventions

Comorbidities, complications and interventions

AMA

No AMA

P value

AMA: against medical advice; COPD: chronic obstructive pulmonary disease; HIV: human immunodeficiency virus; EGD: esophagogastroduodenoscopy; ERCP: endoscopic retrograde cholangiopancreatography.

Comorbidities

Diabetes mellitus

20.6%

26.3%

< 0.001

Hypertension

40.6%

48.4%

< 0.001

Dyslipidemia

13.7%

24.1%

< 0.001

Coronary artery disease

6.8%

12.0%

< 0.001

Peripheral vascular disease

2.1%

4.1%

< 0.001

Atrial fibrillation/flutter

2.1%

6.2%

< 0.001

Inflammatory bowel disease

1.0%

1.4%

< 0.001

Liver cirrhosis

10.9%

8.6%

< 0.001

Chronic kidney disease

5.7%

8.7%

< 0.001

Anemia

17.6%

21.8%

< 0.001

COPD

13.6%

14.6%

< 0.001

Smoking

44.4%

22.6%

< 0.001

Drug abuse

18.4%

6.8%

< 0.001

Depression/psychosis

10.6%

7.1%

< 0.001

HIV infection

3.0%

1.4%

< 0.001

Alcohol

52.3%

23.5%

< 0.001

Biliary pancreatitis

9.5%

22.3%

< 0.001

Other cause of pancreatitis

16.0%

26.6%

< 0.001

Complications

Acute kidney injury

7.3%

12.0%

< 0.001

Respiratory failure

1.8%

5.0%

< 0.001

Sepsis

0.5%

2.1%

< 0.001

Urinary tract infection

0.4%

0.7%

< 0.001

Gastrointestinal bleeding

4.1%

3.0%

< 0.001

Interventions

ERCP

1.8%

9.7%

< 0.001

Endoscopy

4.9%

9.8%

< 0.001

EGD

4.7%

9.0%

< 0.001

Colonoscopy

0.8%

2.1%

< 0.001

Acute kidney injury requiring hemodialysis

1.4%

2.6%

< 0.001

Blood transfusion

3.0%

6.0%

< 0.001

**Table 3.** Multivariate Logistic Regression Analysis for Predictors of Discharge Against Medical Advice Among Patients Admitted With Pancreatitis
Predictors for AMA discharge	OR	95% CI for OR	P value
AMA: against medical advice; COPD: chronic obstructive pulmonary disease; HIV: human immunodeficiency virus; ERCP: endoscopic retrograde cholangiopancreatography; OR: odds ratio; CI: confidence interval; Ref: reference.
Age range
18 - 44	4.138	4.037	4.243	< 0.001
45 - 64	3.214	3.139	3.292	< 0.001
> 65	Ref	Ref	Ref	Ref
Male	1.582	1.564	1.599	< 0.001
Race
White	Ref	Ref	Ref	Ref
Black	1.059	1.045	1.072	0.043
Hispanic	0.929	0.914	0.945	0.001
Urban	1.22	1.206	1.235	0.001
Rural	Ref	Ref	Ref	Ref
Payer
Medicare	Ref	Ref	Ref	Ref
Medicaid	1.159	1.142	1.177	< 0.001
Private insurance	0.5	0.491	0.508	< 0.001
Self-pay/no charge/other	1.074	1.057	1.092	< 0.001
Weekend admission	1.082	1.07	1.094	< 0.001
Income
0 - 25th percentile	1.096	1.079	1.114	< 0.001
26th - 50th percentile	1.053	1.036	1.07	< 0.001
51th - 75th percentile	0.962	0.946	0.979	< 0.001
76th - 100th percentile	Ref	Ref	Ref	Ref
Diabetes mellitus	0.915	0.903	0.927	< 0.001
Hypertension	0.941	0.931	0.951	< 0.001
Dyslipidemia	0.747	0.736	0.758	< 0.001
Coronary artery disease	1.054	1.033	1.076	< 0.001
Peripheral vascular disease	0.794	0.768	0.821	< 0.001
Atrial fibrillation/flutter	0.76	0.735	0.786	< 0.001
Inflammatory bowel disease	0.8	0.762	0.841	< 0.001
Liver cirrhosis	0.912	0.897	0.927	< 0.001
Anemia	0.792	0.782	0.803	< 0.001
COPD	0.974	0.959	0.988	< 0.001
Smoking	1.532	1.515	1.548	< 0.001
Drug abuse	1.443	1.424	1.463	< 0.001
Depression/psychosis	1.048	1.031	1.065	< 0.001
HIV infection	1.251	1.212	1.291	< 0.001
ERCP	0.362	0.348	0.376	< 0.001
Etiology
Alcohol	1.806	1.785	1.827	< 0.001
Biliary pancreatitis	0.851	0.835	0.867	< 0.001
Other cause of pancreatitis	Ref	Ref	Ref	Ref

Table 3. Multivariate Logistic Regression Analysis for Predictors of Discharge Against Medical Advice Among Patients Admitted With Pancreatitis

Predictors for AMA discharge

95% CI for OR

P value

Lower

Upper

AMA: against medical advice; COPD: chronic obstructive pulmonary disease; HIV: human immunodeficiency virus; ERCP: endoscopic retrograde cholangiopancreatography; OR: odds ratio; CI: confidence interval; Ref: reference.

Age range

18 - 44

4.138

4.037

4.243

< 0.001

45 - 64

3.214

3.139

3.292

< 0.001

> 65

Ref

Male

1.582

1.564

1.599

< 0.001

Race

White

Ref

Black

1.059

1.045

1.072

0.043

Hispanic

0.929

0.914

0.945

0.001

Urban

1.22

1.206

1.235

0.001

Rural

Ref

Payer

Medicare

Ref

Medicaid

1.159

1.142

1.177

< 0.001

Private insurance

0.5

0.491

0.508

< 0.001

Self-pay/no charge/other

1.074

1.057

1.092

< 0.001

Weekend admission

1.082

1.07

1.094

< 0.001

Income

0 - 25th percentile

1.096

1.079

1.114

< 0.001

26th - 50th percentile

1.053

1.036

1.07

< 0.001

51th - 75th percentile

0.962

0.946

0.979

< 0.001

76th - 100th percentile

Ref

Diabetes mellitus

0.915

0.903

0.927

< 0.001

Hypertension

0.941

0.931

0.951

< 0.001

Dyslipidemia

0.747

0.736

0.758

< 0.001

Coronary artery disease

1.054

1.033

1.076

< 0.001

Peripheral vascular disease

0.794

0.768

0.821

< 0.001

Atrial fibrillation/flutter

0.76

0.735

0.786

< 0.001

Inflammatory bowel disease

0.8

0.762

0.841

< 0.001

Liver cirrhosis

0.912

0.897

0.927

< 0.001

Anemia

0.792

0.782

0.803

< 0.001

COPD

0.974

0.959

0.988

< 0.001

Smoking

1.532

1.515

1.548

< 0.001

Drug abuse

1.443

1.424

1.463

< 0.001

Depression/psychosis

1.048

1.031

1.065

< 0.001

HIV infection

1.251

1.212

1.291

< 0.001

ERCP

0.362

0.348

0.376

< 0.001

Etiology

Alcohol

1.806

1.785

1.827

< 0.001

Biliary pancreatitis

0.851

0.835

0.867

< 0.001

Other cause of pancreatitis

Ref