Do You Really Need That Surgery?

Unlike drugs, surgical procedures require no proof of safety or efficacy. They’re adopted simply on the assumption that they work. Of course, some of the 75 million operations performed in this country every year are necessary, even lifesaving. But increasing scrutiny of medical costs has led to studies that show many common surgeries are of dubious value, a waste of health care resources, and a cause of costly, sometimes deadly, complications.

Angioplasty. According to findings from the COURAGE trial—the definitive study on elective angioplasty— eight of 10 patients who undergo this procedure are inappropriate candidates who would be better served by more conservative therapy.

Heart Surgery. Harvard cardiologist Thomas Graboys, MD, estimates that 90 percent of coronary artery bypass surgeries—the bread and butter of invasive cardiology—are unnecessary. For the overwhelming majority of patients, this risky procedure has not been proven to prevent heart attacks or death from cardiovascular events.

Arthroscopic Knee Surgery. Researchers at the VA Medical Center in Houston found that for patients with arthritis—which accounts for the bulk of the 650,000 arthroscopies of the knee done every year—placebo or sham surgery (the knee was cut and stitched up but no cartilage was removed) yielded results just as good as the real operation.

Back Surgery. A Dartmouth Medical School team found that lumbar diskectomy, often done on patients with sciatica, is no more effective in relieving pain than noninvasive treatment. And complex spinal fusions, which provide little advantage over simple decompression but cost more than three times as much ($81,000), have increased 15-fold over the past five years.

Hysterectomy and Cesarean Section. Studies suggest that about three-quarters of the 600,000 annual hysterectomies in this country are recommended prematurely and inappropriately. Nearly one in three American women now give birth by C-section, more than double the ideal rate.

Prostate Surgery. Invasive procedures for both prostate cancer and benign, age-related enlargement of the prostate (BPH) are rife with complications and questionable in terms of necessity and long-term success.

Other Surgeries. Gastric bypass and other surgeries for weight loss, tightening of the muscles at the esophagus and stomach to reduce reflux and heartburn, arthroscopy of the shoulder joint, and routine removal of wisdom teeth are other examples of overused surgeries.

If you are told you need to have any invasive procedure, get a second opinion, preferably from a doctor outside your physician’s network, and thoroughly research all your options. Safe, effective, noninvasive alternatives exist for virtually all of these surgical procedures.

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