Up to 30% of surgical procedures in the US are unnecessary. This shocking statistic was recently released by the respected nonprofit, nonpartisan policy analysis group, The Rand Corporation.
The analysis confirms why it’s so crucial to request a second opinion from a physician who is not associated with your doctor before agreeing to any elective surgery.
Procedures that may not be necessary — and alternatives to consider…
Each year, more than one million heart patients are treated with angioplasty and stents, which restore normal circulation to the heart and reduce angina (chest pain).
With angioplasty, a deflated balloon is threaded into the coronary artery. It’s then inflated to flatten plaque (fatty deposits), and a metal stent is placed inside the artery to prevent arterial deposits from reblocking the opening.
Problem: Angioplasty and stents are overused. A study of more than 2,300 patients presented at a recent meeting of the American College of Cardiology found that patients with stable angina, in which discomfort occurs in a consistent pattern (such as during exertion), who were treated with medications (such as nitroglycerine to dilate the blood vessels) had the same outcomes as those treated with stents — without the dangers of an invasive procedure.
Who is helped by stents: Patients with a recent worsening of chest pain (unstable angina). For people with a significant blockage in the left main coronary artery or with three coronary arteries blocked and a weakened heart muscle, bypass surgery (which involves grafting a vein from another part of the body to bypass the blockage) improves life expectancy.
Who isn’t helped by stents: People with stable angina. These patients usually should be treated with medications to control the pain and to reduce blood pressure and cholesterol. Medications are just as effective at preventing future heart attacks and preventing death as stenting in these patients — without the risks of a surgical procedure. Stenting and bypass surgery should be used only in patients for whom medication fails to adequately control chest pain.
About 20% of all strokes are related to blockages in the carotid arteries in the neck. With a procedure known as carotid endarterectomy, the blockages are surgically peeled away to improve circulation to the brain and potentially prevent a stroke.
Problem: Severe carotid blockages (generally blockage of 80% or more) occasionally can lead to “ministrokes” — transient ischemic attacks (TIAs), which often precede a full-blown stroke. But if a person has a severe obstruction and no TIA symptoms, the likelihood of having a major stroke is very small. Performing a carotid endarterectomy in those people decreases the chance of having a stroke by only 0.7%.
Who is helped by carotid endarterectomy: People with severe carotid blockage and TIAs have a 13% risk of having a disabling stroke over the next two years. When a carotid endarterectomy is performed, the risk drops to 2.5%.
Who isn’t helped by carotid endarterectomy: People with a blockage of less than 60% — even if they have a history of ministrokes. In this group, the risk for stroke is higher after surgery — perhaps because the risk of stroke-producing plaque being dislodged during the operation may exceed the patient’s initial stroke risk.
In groups of people with severe obstruction and no TIA symptoms, more than 140 endarterectomies must be performed to prevent one stroke. For obstructions of 60% to 79%, there is no convincing scientific evidence for surgery. Nonsurgical treatment, including the use of aspirin and cholesterol-lowering drugs, is preferable in all of these cases.
About 180,000 American men are diagnosed with prostate cancer each year and about 30,000 die from the disease. Surgical removal of the prostate (prostatectomy) often is recommended, but risks include infection, impotence and incontinence.
Problem: The majority of prostate cancers grow slowly. Most men with the disease would eventually die from an unrelated condition — even if the prostate cancer weren’t treated.
In a recent study published in The New England Journal of Medicine, older men with early prostate cancer who were treated with prostatectomy died at about the same rate as older men with similar cancers who had no surgery.
Who is helped by prostatectomy: Men who are in their 50s and younger with biopsy findings that show an aggressive form of prostate cancer are generally candidates for prostatectomy.
Who isn’t helped by prostatectomy: Men whose life expectancy is less than 10 years at the time of diagnosis. They’re less likely than younger men to die of their cancer and face a high risk for surgical complications. Older men with prostate cancer often do better with hormone therapy and/or radiation.
Surgery for a herniated (ruptured) disk is among the most commonly performed orthopedic procedures in the US.
Problem: A herniated disk that presses on a nerve can be excruciatingly painful. But in 80% to 90% of cases, enzymes secreted by the body break down disk material and the nerve pain disappears in time. This can take many months, so surgery promises faster relief.
Disk surgery, however, has serious potential risks, including nerve injuries, buildups of scar tissue, infection and chronic back pain. A recent study in the Journal of the American Medical Association compared the long-term outcomes of back patients who had surgery with those who didn’t. The likelihood of recovery was virtually the same.
Who is helped by back surgery: People with severe, intractable back pain that radiates into a leg (sciatica) or those with a progressive neurological deficit, such as foot weakness, or a loss of bowel or bladder control, which indicates compression of a spinal nerve, require prompt surgical treatment.
Who isn’t helped by back surgery: People whose only symptom is low back pain. Studies have shown that individuals with local symptoms do better with nonsurgical treatment, including anti-inflammatory drugs, acupuncture, massage therapy and physical therapy. For most people with mild sciatica, the pain usually disappears within a few months as the disk breaks down.
You shouldn’t assume that you need surgery if you suddenly develop pain, inflammation and swelling in one or both knees. Sometimes the pain is from a medical problem such as gout or Lyme disease.
Problem: Even with knee injuries, many surgeons want to repair or remove damaged tissue without waiting enough time to see if normal healing will take place.
Who is helped by knee surgery: People in whom a ligament or tendon is completely severed. For these patients, the knee will rarely heal well enough on its own to restore adequate function and reduce pain. For people who engage in intensive sports, arthroscopic surgery (using a “keyhole” incision) for lesser injuries often is recommended since they may not be willing to wait for healing to occur.
Who isn’t helped by knee surgery: For most people with knee injuries, surgery — even arthroscopic — is the last resort. First, rest the leg, use anti-inflammatory drugs and try physical therapy and braces. Follow this approach for at least one to two months before considering knee surgery.
