Surgery is common in older people during the last year, month and even week of life, researchers reported Wednesday, a discovery that is likely to stimulate the debate regarding whether patients are being over treated.
In a 2008 national study, published Wednesday in The Lancet, nearly one recipient in three had surgery in the last year of life. Nearly one in five had surgery in the last month of life. Nearly one in 10 had surgery in the last week of life.
Furthermore, findings indicated the oldest patients were less likely to have surgery. Those who were 65 had a 38.4 percent chance of having surgery in the last year of life. For 80-year-olds, the chance was 35.3 percent, but the rates fell off more sharply from there, declining by a third by age 90, The New York Times reports.
However, these results are controversial. Critics claim that by merely observing those who died, researchers may obtain a distorted perception of reality.
“Because the patient died, you can’t assume that the treatment and therapies were not of value,” said Dr. Peter B. Bach of Memorial Sloan-Kettering Cancer Center, as quoted by The New York Times. “Although in that individual, things may not have worked out, you have no insight into whether the decision to operate was appropriate.” Nor is it known how many similar patients who had that same surgery did not die.
Researchers at Harvard School of Public Health said the total number of operations at the end of life was surprising and they did not know why the operations had been performed. Some were necessary to alleviate pain and suffering or to extend life. However, they said, doctors often operate to repair something that can be fixed, but that will not save a dying patient.
In their study, the researchers investigated data for all the 1,802,029 Medicare recipients 65 and older who died in 2008. In addition to the number of operations nationally, they reported distinct regional differences in surgery at the end of life.
Regional differences in health care have been controversial because it is unknown whether they reflect accurate variations in patient needs, in health care practices or regional differences in health care payment rules, Dr. Bach said, according to the New York Times.
“I will admit to being guilty of this,” Dr. Ashish Jha said, an associate professor of health policy at Harvard and the lead author of the study, as quoted by The New York Times. “Often we say, ‘If you have this intervention, we will be able to fix that problem. You have an intestinal blockage. Surgery will fix it.’ But will it let you walk out of the hospital alive? Will it let you return to your old life?”
Their study addressed a major issue in American medicine, researchers said. Surgery, which can be expensive and painful, is tempting for both doctors and patients.
Dr. Jha said he and his colleagues were continuing to study the causes and effects of surgery at the end of life. “As clinicians, we often end up focusing on something narrow and small that we think we can fix,” Dr. Jha added. “That leads us down the path of surgical intervention. But what the patient cares about is not going to get fixed.”
