Ann Plast Surg. 2025 Mar 6. doi: 10.1097/SAP.0000000000004310. Online ahead of print.
ABSTRACT
BACKGROUND: Patient-directed discharge (PDD) poses a significant challenge in healthcare. Prior studies have shown associations of PDD with factors like race, housing, psychiatric illness, socioeconomic status, and intravenous drug use (IVDU). This study aims to identify factors contributing to PDD in hand infection patients at a public safety-net hospital and to investigate the long-term consequences through readmissions or returns to the emergency department (ED).
METHODS: A retrospective analysis was conducted on adult patients presenting with hand infections at San Francisco's main public hospital over 1 year. Data collected included demographics, housing status, social support, psychiatric diagnoses, and IVDU. Statistical analysis involved Mann-Whitney U tests, Fisher's exact tests, and logistic regression with odds ratios (ORs).
RESULTS: A total of 131 patients were included, comprising 95 (73%) conventionally discharged and 36 (27%) PDD patients. Positive correlations were found between PDD and several factors, including unemployment, unstable housing, living alone, lack of a phone number on file, alcohol use, and IVDU. However, in the multivariate analysis, IVDU emerged as the sole statistically significant predictor (OR, 4.22; CI, 1.18-15.05; P = 0.026). Further regression analysis identified unstable housing (OR, 4.39; CI, 1.17-16.44; P = 0.028) and living alone (OR, 4.45; CI, 1.25-15.89; P = 0.021) to be positively correlated with IVDU. PDD had higher ED revisits (P = 0.025) and readmission rates (P = 0.014).
CONCLUSIONS: This study underscores the critical role of socioeconomic factors, particularly IVDU, in influencing PDD among hand infection patients. The findings highlight the need for integrated healthcare strategies addressing medical and social determinants to reduce PDD and improve patient outcomes.
PMID:40084988 | DOI:10.1097/SAP.0000000000004310