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One in three people on Medicare have surgery in the final year of their lives, and many have surgery in their last month, according to a new study published in The Lancet.
Of the 1.8 million Medicare patients over age 65 who died in 2008, researchers found that a third had undergone surgery in the year before death and that 18% of those surgeries had occurred in the month before death. Nearly 1 in 10 had surgery in their final week. The numbers were surprisingly high, researchers said.
To some extent, the finding makes sense: sick people have surgery and sick people also die. But while the researchers did not examine whether individual surgeries were necessary or whether they improved patients' quality of life — many surely did — the data suggested they did not improve outcomes overall. Areas of the country that had high rates of surgery also had high rates of death.
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Geography had a lot to do with a Medicare patient's likelihood of having surgery in the last year of life. Muncie, Ind., had the highest rate, at 34%, while Honolulu had the lowest, at 12%. Why that's so isn't clear, but the authors suggested several possible contributing factors, including population health, patterns of medical practice, culture and availability of end-of-life services such as hospice care.
Rates of surgery also differed by age. About 38% of 65-year-old Medicare patients had surgery in the year they died, compared with 35% of 80-year-olds — not a very vast difference. But rates of surgery dropped off more sharply in patients older than 80, with fewer than 24% of patients between 80 and 90 having surgery, suggesting that surgeons had greater concerns about the risk of complications in this age group.
Given the patterns in surgery rates across the country, the authors suggest that medical need is not the only factor driving doctors' desire to operate. Many surgeries may be done to avoid difficult discussions about patients' prognosis, or to fix problems that wouldn't necessarily prolong life or improve its quality, the authors said. Doctors are also failing to figure out exactly how dying patients wish to spend their final days.
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"In a lot of places, we're doing a lot of these surgeries I think unnecessarily," lead author Ashish Jha, a professor of health policy and management at the Harvard School of Public Health, told Bloomberg. "We're not having the kinds of conversations with patients that we need to have, about what they want out of their last few days and how we help them achieve those goals."
Reported Bloomberg:
Doctors and hospitals may have a financial incentive to operate on dying seniors "regardless of the patient's preferences or goals," because Medicare is guaranteed to pay for the procedures, said Amy Kelley, an assistant professor of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine in New York.
In an accompanying comment in The Lancet, Kelley wrote that doctors', insurance companies' and hospitals' incentives must be aligned with the wishes of the patient. She also suggested that another to way to increase the likelihood that patients get the care they want is to ensure that all medical and nursing school students receive basic education in end-of-life care
The study is not without its limitations, however. For example, researchers looked only at surgery patients who died; it's not known how many patients who had the same procedure survived.
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Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.
Variety, color and presentation go a long way toward fooling your stomach. Taste buds learn to love the food they're with -- so make a commitment to wholesome foodsEat small amounts of dark chocolate every day to avoid bingeing on sweetsHide your craving food in a hard-to-get-to place so you have to work to find it
Legionnaires' disease is caused by bacteria and is a form of pneumonia There have been nine cases of Legionnaires' disease in the UK, all linked to travel to Corfu since August, according to the Health Protection Agency.
ATLANTA (AP) — Drunken driving incidents have fallen 30 percent in the last five years, and last year were at their lowest mark in nearly two decades, according to a new federal report.The decline may be due to the down economy: Other research suggests people are still drinking as heavily as in years past, so some may just be finding cheaper ways of imbibing than by going to bars, night clubs and restaurants."One possibility is that people are drinking at home more and driving less after drinking," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.The CDC statistics — released Tuesday — are based on a 2010 national telephone survey of about 210,000 U.S. adults. The respondents were kept anonymous.Nearly 1 in 50 said they'd driven drunk at least once in the previous month. That equates to about 4 million Americans driving drunk last year.About 60 percent said they drove drunk just once, but some said they did it daily.That led to a CDC estimate of more than 112 million episodes of drunken driving in 2010. That's more than 300,000 incidents a day.CDC officials lamented that finding; still, it was the lowest estimate since the survey question was first asked in 1993, and down significantly from the 161 million incidents in the peak year of 2006.Young men ages 21 to 34 were the biggest problem, accounting for just 11 percent of the U.S. population but 32 percent of the drunken driving incidents.The overwhelming majority of drunken driving incidents involve people who had at least four or five drinks in a short period of time. But binge drinking has not been on the decline, other health research suggests.The National Highway Traffic Safety Administration has also noted signs of an apparent recent decline in drunken driving. According to that agency's latest data, the number of people killed in U.S. crashes involving alcohol-impaired drivers dropped from 11,711 in 2008 to 10,839 in 2009."While the nation has made great strides in reducing drunk driving over the years, it continues to be one of the leading causes of death and injury on America's roads — claiming a life every 48 minutes," added David Strickland, the agency's administrator, in a prepared statement.___Online:CDC report: http://www.cdc.gov/vitalsignsAssociated Press 
FILE - In this Jan. 6, 2004 file photo, Apple CEO Steve Jobs displays the iPod mini at the Macworld Conference and Expo in San Francisco. Jobs, the Apple founder and former CEO who invented and masterfully marketed ever-sleeker gadgets that transformed everyday technology, from the personal computer to the iPod and iPhone, died Wednesday. He was 56. (AP Photo/Marcio Jose Sanchez, File)
FILE - In this April 24, 2009 file photo, Dr. Ralph Steinman of Rockefeller University speaks during a news conference in Albany, N.Y. Rockefeller University in New York says Ralph Steinman, co-winner of this year's Nobel Prize in medicine, has died. The university says Steinman was diagnosed with pancreatic cancer four years ago and died on Sept. 30, three days before the announcement. (AP Photo/Mike Groll, File)
FILE - In this Jan. 15, 2008, file photo, Apple CEO Steve Jobs holds up the new MacBook Air after giving the keynote address at the Apple MacWorld Conference in San Francisco. Apple on Wednesday, Oct. 5, 2011 said Jobs has died. He was 56. (AP Photo/Jeff Chiu, File)
Fred Velez, of San Francisco, holds an Apple iPhone displaying an early picture of Steve Jobs, as he and others gather outside an Apple store in San Francisco on Wednesday, Oct. 5, 2011. Jobs, the Apple founder and former CEO who invented and masterfully marketed ever-sleeker gadgets that transformed everyday technology, from the personal computer to the iPod and iPhone, died Wednesday. He was 56. Apple announced his death without giving a specific cause. He died peacefully, according to a statement from family members who said they were present. (AP Photo/Darryl Bush)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); 
If blood sugar levels drop too far it can lead to unconsciousness The cause of a rare and severe form of hypoglycaemia - or very low levels of sugar in the blood - is genetic, say researchers.
Can you lose weight by changing your mindset? 'Nudging' people to lose weight by thinking about their lifestyle shows little evidence of success, an analysis of published data suggests.
"It's an insurance policy," Dr. Rachel Wellner says of freezing her eggs. An estimated 5,000 women nationwide are using egg-freezing technologyProcess costs thousands of dollars and it doesn't always workAmerican Society for Reproductive Medicine hasn't endorsed egg freezing
Managers have told the BBC that cuts are being presented as modernisation Health service managers have called on the government to be more honest about the financial challenges facing the NHS in England.
Visuals Unlimited, Inc. / Dr. Gladden Willis / Getty Images
Steve Jobs had a pancreatic neuroendocrine tumor. Apple Inc. announced his death Wednesday.About 95 percent of people with pancreatic cancer die from it, experts sayAs people age, the risk of developing pancreatic cancer goes upThe pancreas is an oblong organ that lies deep in the abdomenThere are two types of pancreatic cancer: exocrine tumors and endocrine tumors
This Tuesday, Oct. 4, 2011 photo shows Debbie Wingard in her office at the University of California-San Diego where she is a professor. Wingard has had breast cancer twice and has been unable to conceive which she believes is due to her mother's use of the drug DES during pregnancy. The drug that millions of pregnant women took decades ago to prevent miscarriage and complications has put their daughters at higher risk for breast cancer and other health problems that are showing up now, a new federal study finds. (AP Photo/Lenny Ignelzi)
This Wednesday, Oct. 5, 2011 photo shows Jackie White in Branchville, N.J. White, a breast cancer survivor and a DES daughter who lives in Centerburg, Ohio, north of Columbus, said she had a misshaped uterus and reproductive problems, and found a lump last year that turned out to be breast cancer. Tests showed 20 tumors in one breast, two pre-cancers in the other and spread to her lymph nodes. The drug that millions of pregnant women took decades ago to prevent miscarriage and complications has put their daughters at higher risk for breast cancer and other health problems that are showing up now, a new federal study finds. (AP Photo/Julio Cortez)
This Tuesday, Oct. 4, 2011 photo shows Debbie Wingard outside the Stein Clinical Research building at the University of California-San Diego where she is a professor. Wingard has had breast cancer twice and has been unable to conceive which she believes is due to her mother's use of the drug DES during pregnancy. The drug that millions of pregnant women took decades ago to prevent miscarriage and complications has put their daughters at higher risk for breast cancer and other health problems that are showing up now, a new federal study finds. (AP Photo/Lenny Ignelzi)
This Wednesday, Oct. 5, 2011 photo shows Jackie White in Branchville, N.J. White, a breast cancer survivor and a DES daughter who lives in Centerburg, Ohio, north of Columbus, said she had a misshaped uterus and reproductive problems, and found a lump last year that turned out to be breast cancer. Tests showed 20 tumors in one breast, two pre-cancers in the other and spread to her lymph nodes. The drug that millions of pregnant women took decades ago to prevent miscarriage and complications has put their daughters at higher risk for breast cancer and other health problems that are showing up now, a new federal study finds. (AP Photo/Julio Cortez)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); 
