Many Elderly in U.S. Undergo Surgery in Last Year of Life

Rate of surgery varies with age, region, availability of hospital beds, Medicare spending

THURSDAY, Oct. 6 (HealthDay News) -- A considerable proportion of elderly people in the United States undergo surgery in the year before their death, with the rate varying with age and geographical region, according to a study published online Oct. 6 in The Lancet.

Alvin C. Kwok, M.D., from the Harvard School of Public Health in Boston, and colleagues examined national patterns of surgical care in the last year of life for 1,802,029 elderly fee-for-service Medicare beneficiaries aged 65 years or older who died in 2008. Claims for inpatient surgical procedures in the year before death were identified and their correlation with both age and geographical region were examined. End-of-life surgical intensity (EOLSI) scores for each hospital referral region were calculated after adjusting for age, gender, race, and income.

The investigators found that 31.9, 18.3, and 8.0 percent of the decedents underwent an inpatient surgical procedure during the year before death, their last month of life, or their last week of life, respectively. The percentage of decedents who underwent a surgical procedure in the last year of life decreased by 33 percent from age 80 to age 90 years (from 35.3 to 23.6 percent). The EOLSI score was 34.4 and 11.5 in the highest and lowest intensity regions, respectively. A high EOLSI score was seen in regions with a high number of hospital beds per head and in regions with high total Medicare spending.

"Nearly a third of elderly Americans had a surgical intervention during the last year of life and most of these procedures occurred in the month before death," the authors write.

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