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Background Approximately 500,000 patients are discharged from U.S. hospitals against medical advice annually, but the associated risks are unknown. Methods We examined 148,810 discharges from an urban, academic health system between 7/1/2002 and 6/30/2008. Of these, 3,544 (2.4%) were discharged against medical advice and 80,536 (54.1%) were discharged home. We excluded inpatient deaths, transfers to other hospitals or nursing facilities, or discharges with home-care. Using adjusted and propensity score matched analyses, we compared 30-day mortality, 30-day readmission, and length of stay between discharges against medical advice and planned discharges. Results Discharge against medical advice was associated with higher mortality than planned discharge, after adjustment (ORadj = 2.05, 95% CI: 1.48–2.86), and in propensity-matched analysis (ORmatched = 2.46, 95% CI: 1.29 – 4.68). Discharge against medical advice was also associated with higher 30-day readmission after adjustment (ORadj 1.84; 95% CI 1.69 – 2.01), and in propensity-matched analysis (ORmatched 1.65, 95% CI: 1.46 – 1.87). Finally, discharges against medical advice had shorter lengths-of-stay than matched planned discharges (3.37 vs. 4.16 days, p <0.001). Conclusions Discharge against medical advice is associated with increased risk for mortality and readmission. In addition, discharges against medical advice have shorter lengths-of-stay than matched planned discharges, suggesting that the increased risks associated with discharge against medical advice are attributable to premature discharge.

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