THURSDAY, Oct. 6 (HealthDay News) -- As many as one-third of
Medicare beneficiaries in fee-for-service plans have inpatient
surgery in the last year of their life, a new Harvard study
But the issue of whether such surgery is necessary or not is a
tricky one that can only be decided by the doctor, the patient and
patient's family, said Dr. Frank Opelka, an associate medical
director at the American College of Surgeons.
Nor is there any good way to predict when an elderly patient is
going to die.
"There's no way possible to know ... if it's the person's last year of life," said Jane Bolin, an associate professor of health policy and management at Texas A&M Health Science Center School of Rural Public Health in College Station. "The doctor doesn't know. The patient doesn't know."
Dr. Alvin Kwok and colleagues published their findings in the
Oct. 6 online edition of
It's been well-noted that treatment intensity tends to step up
at the end of a person's life, often involving intensive-care
stays, ventilators and pulmonary resuscitation in the days before
Less is known about surgery at this vulnerable period of
By analyzing Medicare claims data the study authors found that,
in a group of almost 2 million elderly beneficiaries, all of whom
died in 2008, almost one-third had inpatient surgery in the year
before they died, almost one in five in the last month of their
lives and almost one in 10 in the week before they took their last
As participants progressed in age, the proportion of people
undergoing surgery declined: 38.4 percent among 65-year-olds, 35.3
percent at age 80 and 23.6 percent for those between 80 and 90.
The most surgeries were performed in Munster, Ind., and the
fewest were done in Honolulu; surgeries tended to be more common in
hospitals with more beds available.
An accompanying commentary from Dr. Amy S. Kelley of Mount Sinai
School of Medicine in New York City pointed out that Medicare
reimbursement rates for surgery are highly lucrative, suggesting
that "surgeons and hospitals are often financially motivated to
operate, regardless of the patient's preferences or goals."
But other experts disagreed that this might be the case.
"I do not know a single surgeon who says, 'We're going to do this because there's a financial incentive,'" Opelka said. "These patients are absolutely facing the most difficult time in their life, and the profession just doesn't act that way."
Instead, the issue might be one of how the medical community and
the larger community might start discussing the inevitability of
"We want to do everything we can when we have the opportunity but when we reach a point of futility, we have to have a mature conversation," Opelka said. "It's no longer about getting past an acute, life-threatening situation but the inappropriate prolonging of the dying process, giving the patient dignity and control of a God-given process," he noted.
"We've grown up believing we can get anything and buy anything," Opelka added. "We can't buy eternity."
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