Is a surgical procedure that will extend a patient's life a year worth the risk and cost to the patient? What about a month? A week? A study appearing in the Oct. 6 issue of the British journal Lancet suggests that such procedures are essentially undertaken with surprising frequency.
For the study, researchers from the Harvard School of Public Health reviewed data for the 1.8 million Medicare patients aged 65 years and older nationwide who died in 2008. Instead of analyzing the facts of their hospitalization or intensive care treatment, they focused on the surgical care these patients received.
What they found surprised them. Almost 32% of these patients underwent surgery in the 12 months before their deaths. Another 18% had surgery in the last month of their life, and 8% in their last week. (Their analysis did not record the reasons for the patients' surgeries.)
These findings are raising questions about how often physicians and elderly patients resort to potentially risky, often expensive procedures — and ultimately how useful they are to the patients' continued health and survival.
"As clinicians, we often end up focusing on something narrow and small that we think we can fix," study co-author Ashish Jha, MD, MPH, told the New York Times. "That leads us down the path of surgical intervention. But what the patient cares about is not going to get fixed."
Perhaps a better course of treatment would be interventions to manage a dying patient's pain or other complications, allowing them to make decisions and hold conversations outside of the effects of surgery and anesthesia, suggests Dr. Jha.
These speculations are ripe grounds for debate, however. Just "because the patient died, you can't assume that the treatment and therapies were not of value," Peter B. Bach, MD, of Memorial Sloan-Kettering Cancer Center told the Times.
David Bernard
