Unnecessary Surgeries Prevalent Among Patients Nearing End of Life

Surgeries near the end of life are extremely common. According to The Lancet, among those who died aged 65 or older in the United States in 2008, nearly one third underwent surgery in the last year of life, and almost one-fifth had surgery in the final three months of life. While surgery seems a normal procedure for someone at this stage of life, it is important to consider the issues and possible risks of unnecessary surgeries.

The Cost of Unnecessary Surgeries

Western culture tends to treat disease aggressively. We have for decades been driven by the need to cure disease, and, as such, some medical decisions are anticipatory. The downside of over-diagnosis or anticipatory surgery is that they can turn healthy individuals into patients. Furthermore, many of these surgeries are funded by Medicare, which removes the barrier of cost from the decision-making process for both the doctor and the patient. This can be an issue because the total cost of these procedures involves more than just money.

Older patients who go for surgical procedures in their last year of life spend more of their final days in hospitals, much of this time in intensive care. This can diminish the quality of one’s final months with friends and family. Not only that, end-of-life surgery is risky. According to the American Medical Association, 20 percent of seniors who undergo urgent abdominal surgery die within 30 days.

Why Agree to Unnecessary Surgeries?

One might wonder why anyone nearing the end of life would choose to undergo potentially risky and unnecessary surgeries. There are a few reasons that may come into play here. First, older patients tend to treat doctors as infallible, and feel uncomfortable about second-guessing their advice or recommendations. Some even fear diminished quality of treatment if they question their doctor’s expertise.

Additionally, there is another, perhaps more fundamental, reason so many seniors agree to these risky procedures — fear of mortality. A 2016 article in the journal of Annals of Surgery revealed that quality of life is difficult to incorporate into acute surgical decisions, while the question of life or death proves inescapable. This suggests a deficit in public knowledge concerning the risks of surgery for the elderly. Further, it highlights a broad cultural desire to survive at all costs. Even if the costs are dying with diminished quality of life.

Where to go from here?

There is progress being made in finding remedies for these situations. The most important step is slowing down the decision-making process. Many hospitals now offer help with decision making with media aids that require patients to spend adequate time deciding. In Washington state, there have been huge decreases in hip and knee replacements since Kaiser Permanente introduced these kinds of tools. A growing number of practitioners now recommend speaking to patients using narratives instead of numbers—specifically, best-case and worst-case scenarios. The formula here is simple. If the worst-case scenario is not a situation the patient can live with, it’s time to consider other options.