Nearly one of every three Americans on Medicare undergoes surgery in their last year of life, according to a new study. Those numbers are leading experts to question whether these costly and invasive procedures are the right prescription for dying patients and a bloated health care system.

The study, published in The Lancet, analyzed more than 1.8 million claims for Medicare patients who died in 2008, and found that 32 percent of them had an operation in the year before they died. Nearly one in five had a surgical procedure in the last month of life and one in 10 went under the knife in the last week of life.

Dr. Ashish Jha, the study's author and an associate professor of health policy at the Harvard School of Public Health, said it's well known that patients receive lots of health care at the end of their lives, but this study is the first to show how many of them are getting costly, invasive surgery, and then dying.

"This level of surgical intensity doesn't seem to be having much in the way of benefit for the population," Jha said. "Our sense is that there are probably lots of unnecessary procedures that go on at end of life."

The study found that a patient's likelihood of getting surgery varied greatly depending on their age and where they lived. Surgery was more common for 65-year-olds than for patients in their 80s and 90s. Operations also became more likely in regions with greater availability of hospital beds and higher levels of Medicare spending.

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All this surgery didn't necessarily prolong life. Areas where doctors did lots of operations had higher patient death rates.

Ken Thorpe, a professor of health policy at Emory University, said doctors and health care systems should reevaluate the kinds of interventions they give to patients who may not live long enough to really benefit from their treatments.

"Researchers are finding that these aggressive procedures have the same outcomes as less invasive, less expensive treatments," he said. "This study shows us there's an enormous opportunity to basically save money and provide less intervention, and still have the same quality of care and life expectancy."

The study also suggests that more dying people have surgery not because they want it or need it to save their lives, but because American medical culture encourages aggressive care like surgery, even at the end of a patient's life.

Dr. Frank Opelka, the associate medical director for the American College of Surgeons, said a doctor's knee-jerk reaction is to do anything possible to prolong a patient's life or ease suffering. And it's often not clear whether a patient will live or die until the final weeks and days of their life.

"Sometimes, it's just impossible to tell whether a treatment or surgery will be futile or not," Opelka said. "But you're going to operate, hoping for the best."

Jha said it's impossible to tell from the Medicare claims analyzed in the study whether surgery was really necessary or whether patients and their families wanted an operation. But he said it underscores a general hesitation by doctors to discuss a difficult subject with their patients: that they might die.

"A lot of physicians struggle to talk about prognosis, whether people are going to live or die. Instead they focus on trying to make little things better," Jha said. "Some of these procedures are a distraction from what might really be important for patients, like being able to spend time with family, being able to say goodbye to people they love, or what their quality of life will look like."

Experts say this study highlights the need for doctors and patients to talk about palliative care options as well as more aggressive treatments like surgery.

"We need to provide patients options for how aggressive they want to be toward the end of life," Thorpe said.

Another notable thing about the research, which was published in the journal Nature: The team paid the women who provided the eggs used in the study, a practice that has been forbidden by ethical guidelines from scientific organizations around the world.  Some ethicists have argued that paying women for their eggs might create an exploitative trade. But in this case, it may be the reason why the researchers were able to collect enough healthy eggs (they used 270 in all) to get their historic result.

Teams have "tried to recruit donors on altruistic grounds and failed," said New York Stem Cell Foundation researcher and study co-leader Dieter Egli, during a press conference on Tuesday.  "That's why we knew it was not the way to go in New York."

Dr. Robert Lanza, a stem cell researcher with Advanced Cell Technology in Worcester, Mass., told The Times that in his experience, it can take a year to get one donor, and perhaps five to 10 eggs, lined up.  

"One year we put out an ad.  The problem was, we got these patients, they'd say sure, and then they'd see the poster down the hall about getting paid [to donate eggs] for reproduction," he said.  "It's hard to get volunteers.  At best you'll get a handful of eggs."

To avoid exerting undue influence on the donors, the New York team paid them ,000 for the time and burden of donation (which does pose risks), then allowed them to decide later if they wanted their eggs to be used for research or for reproduction. That way, the conversation about payment was already over before any talk about scientific research began.

In an article that accompanied the New York study in Nature, medical ethicist Jan Helge Solbakk of the University of Oslo praised the researchers for their approach.  "The authors' approach represents the first step towards acknowledging women as genuine participants -- co-producers even -- in the generation of new knowledge," he wrote.

Marcy Darnovsky, associate executive director of the Center for Genetics and Society in Berkeley, Calif., saw it differently. 

"This new form of research cloning ... still represents a highly speculative approach to stem cell research. We should not put the health of young women at risk, especially to get raw materials for such exploratory investigations,” she said, in a statement released late Wednesday in conjuction with leaders of other women's health organizations.

Click here to access the study and click here to access the accompanying article from Nature (subscription required).  The statement from the Center for Genetics and Society is available here.