One out of three elderly Americans covered under Medicare plans undergo surgery in the last year of their life, a new study shows.
Medicare reimbursement and the availability of hospital beds are more likely to influence a doctor's decision to operate than a patient's need or desire, according to the study published in the latest issue of Britain's Lancet medical journal.
"While some of these surgeries are clearly needed and helpful to patients, probably a substantial portion are not," lead researcher Ashish Jha of the Harvard School of Public Health told Reuters.
"We (physicians) don't really ask patients what they want and we end up doing a lot of procedures," he said.
The number of patients receiving surgery toward the end of their lives is higher in regions with high total Medicare spending, the study found.
For example, the rate of end of life surgeries was three times greater in the Munster, Indiana region than in Honolulu.
The study, which looked at data from more than 1.8 million beneficiaries of the government's Medicare health plan who were aged 65 years or older and died in 2008, also found that about one in five elderly patients underwent a surgical procedure in the last month of life.
Doctors should consider the benefits of surgery on elderly patients more carefully before performing procedures that may not improve their quality of life, Jha concluded.
In addition to regional differences, the study found decisions to perform surgery on elderly Americans during the last year of their lives are more likely to be influenced by the patient's age than a patient's need or desire for such procedures.
The likelihood of undergoing a surgical procedure declined significantly as patients get older, Jha's team found.
About 38 percent of patients underwent surgery at age 65, 35 percent by age 80, while only 24 percent had surgery when they lived to between the ages of 80 and 90.
Jha said physicians need to talk to patients who are about to die and inform them that a procedure may not necessarily improve their quality of life.