一项最新研究显示，许多美国老年人晚年接受不必要的手术，不但无益健康，反而平添痛苦。
路透社10月7日援引报告内容报道，研究人员查看180万名依赖医疗保险项目的65岁及以上美国老年人就医信息后发现，三分之一老人晚年做过手术，五分之一的人在生命最后一个月上过手术台。
报告写道，与患者自身需求相比，医疗保健项目的返还条款、医院空床位数量等因素更多左右着医生是否决定让病人手术。
“尽管其中一些手术确实必要且对患者有益，但相当大一部分可能完全没必要，”研究牵头人、哈佛大学公共卫生学院学者阿希什·贾阿说，“我们（医生）并未真正询问患者所需，便做了许多手术。”
贾阿认为，医生应当在作决定前认真考虑实施手术是否对老年患者有益，尽量避免那些无助于改善他们生命质量的手术。
这项研究报告刊载于最新一期《柳叶刀》杂志。
相关英文论文摘要：
The intensity and variation of surgical care at the end of life: a retrospective cohort study
Background
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. We examined national patterns of surgical care in the USA among elderly fee-for-service Medicare beneficiaries in their last year of life.
Methods
We did a retrospective cohort study of elderly beneficiaries of fee-for-service Medicare in the USA, aged 65 years or older, who died in 2008. We identified claims for inpatient surgical procedures in the year before death and examined the relation between receipt of an inpatient procedure and both age and geographical region. We 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. We compared patient characteristics with Rao-Scott χ2 tests, resource use with generalised estimating equations, regional differences with generalised estimating equations Wald tests, and end-of-life surgical intensity scores with Spearman's partial-rank-order correlation coefficients.
Findings
Of 1 802 029 elderly beneficiaries of fee-for-service Medicare who died in 2008, 31·9% (95% CI 31·9—32·0; 575 596 of 1 802 029) underwent an inpatient surgical procedure during the year before death, 18·3% (18·2—18·4; 329 771 of 1 802 029) underwent a procedure in their last month of life, and 8·0% (8·0—8·1; 144 162 of 1 802 029) underwent a procedure during their last week of life. Between the ages of 80 and 90 years, the percentage of decedents undergoing a surgical procedure in the last year of life decreased by 33% (35·3% [95% CI 34·7—35·9; 8858 of 25 094] to 23·6% [22·9—24·3; 3340 of 14 152]). EOLSI score in the highest intensity region (Munster, IN) was 34·4 (95% CI 33·7—35·1) and in the lowest intensity region (Honolulu, HI) was 11·5 (11·3—11·7). Regions with a high number of hospital beds per head had high end-of-life surgical intensity (r=0·37, 95% CI 0·27—0·46; p<0·0001), as did regions with high total Medicare spending (r=0·50, 0·41—0·58; p<0·0001).
英文论文链接：https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61268-3/abstract
