Ethicalness of surgical care at end of life

Although the extent of hospital and intensive-care use at the end of life is well known, patterns of surgical care during this period are poorly understood. A study1 that appears in a recent issue of The Lancet examines national patterns of surgical care in the United States among elderly fee-for-service Medicare beneficiaries in their last year of life.

Participants of the retrospective cohort study consisted of elderly beneficiaries of fee-for-service Medicare in the United States, aged 65 years or older, who died in 2008. Researchers identified the claims for inpatient surgical procedures in the year before death and examined the relationship between receipt of an inpatient procedure and age and geographical region. The authors of the study then calculated an end-of-life surgical intensity (EOLSI) score for each hospital referral region defined as proportion of decedents who underwent a surgical procedure during the year before their death, adjusted for age, sex, race, and income.

The study revealed that of the elderly beneficiaries of fee-for-service Medicare who died in 2008, about 32% underwent an inpatient surgical procedure during the year before death, 18% underwent a procedure in their last month of life, and 8% underwent a procedure during their last week of life. The study also showed that many elderly people in the United States undergo surgery in the year before their death. The rate at which they undergo surgery varies substantially with age and region and might suggest discretion in the healthcare providers' decisions to intervene surgically at the end of life.


  1. Kwok A, Semel M, Lipsitz S, et al. The intensity and variation of surgical care at the end of life: A retrospective cohort study. Lancet 2011; 378:1,408-1,413.