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Late in life surgery
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October 07, 2011, 03:47 PM
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From the NYT:
Surgery Rate Late in Life Surprises Researchers
By GINA KOLATA

Surgery is surprisingly common in older people during the last year, month and even week of life, researchers reported Wednesday, a finding that is likely to stoke, but not resolve, the debate over whether medical care is overused and needlessly driving up medical costs. 
The most comprehensive examination of operations performed on Medicare recipients in the final year of life found that nationally in 2008, nearly one recipient in three had surgery in the last year of life. Nearly one in five had surgery in the last month of life. Nearly one in 10 had surgery in the last week of life. 
The very oldest patients were less likely to have surgery. Those who were 65 had a 38.4 percent chance of having surgery in the last year of life. For 80-year-olds, the chance was 35.3 percent, but the rates fell off more sharply from there, declining by a third by age 90. ... 
But the sheer number of operations at the end of life was unexpected, said the researchers, at Harvard School of Public Health.
I`m not sure why this is so unexpected. I can imagine a lot of different scenarios under which surgery precedes death, such as:
  •  "We`ll just open up the abdomen like this, remove the one malignant tumor and ... uh-oh."
  • "I`ve extracted the second bullet, so where`s the third slug? Where`s the third goddam ... Uh-oh."
  • "In this kind of routine operation, the only thing we surgeons have to worry about is causing massive sepsis by nicking the bowel with the scalpel. ... Uh-oh."
This kind of study always reminds me of the department store owner who said that half of his advertising budget was wasted, he just didn`t know which half. If you knew the exact date of your death you could avoid a lot of wasted medical care, life insurance, and much else.