Do You Really Need That Surgery?Posted: October 31, 2013
Before you agree to undergo a surgical procedure, ask yourself if it really needs to be done. Based on some of the latest research, there’s a good chance that it doesn’t.
Shocking statistic: Nearly one-third of all health-care dollars are spent on unnecessary medical services, including tens of thousands of surgeries. This alarming statistic is a good reminder that everyone should get a second opinion.
Procedures you should question—and possible alternatives…
It’s one of the most commonly performed orthopedic procedures in the US.
Problem: A herniated disk in the neck that presses on a nerve can cause severe pain and sometimes numbness and tingling that extends down an arm and into the hand. However, the bulging or rupturing of a disk herniation usually corrects itself over weeks to months.
Important finding: A recent study found that 23% of patients with neck problems had been advised to have surgery, even though they didn’t meet the commonly accepted criteria of MRI or CT evidence of a spinal nerve root with pain and weakness throughout that nerve.
Disk surgery has serious potential risks, including nerve damage, infection and chronic postoperative pain.
Who does need neck surgery: People with persistent, severe pain that interferes significantly with their daily lives…or those with significant muscle weakness in the arm or hand that’s caused by pressure on the nerve.
Who doesn’t need neck surgery: Individuals whose only symptoms are pain, tingling or numbness. They often do well with nonsurgical measures such as anti-inflammatory medications, physical therapy, localized steroid injections and massages. Symptoms for the majority of people with a ruptured cervical disk will improve in time.
About 35% to 40% of older Americans have gallstones, lumps of cholesterol, calcium salts and other substances that can be as small as a grain of salt or as large as a golf ball. In about 90% of cases, the stones cause no symptoms at all.
Problem: Doctors often recommend a cholecystectomy, the removal of the gallbladder, for cholecystitis, an inflammation of the gallbladder characterized by pain in the upper-right quadrant of the abdomen along with fever, nausea and vomiting. Cholecystitis is usually caused by gallstones blocking the outflow from the gallbladder.
Surgery to remove the gallbladder presents risks. The traditional open cholecystectomy and the more commonly done laparoscopic technique carry such risks as infection…peritonitis (inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen)…bile leakage…and even death.
Who does need gallbladder surgery: People who have acute cholecystitis with blockage in the pancreatic or common bile duct almost always have surgery. Other people with acute cholecystitis, who are otherwise healthy, usually have their gallbladders removed.
Who doesn’t need gallbladder surgery: Twenty percent of Americans have vague abdominal pains. Many of them coincidentally also have gallstones. A cholecystectomy in those people rarely provides any benefit and subjects them to the risks of the procedure.
Isolated acute cholecystitis without involvement of the common bile duct usually resolves in days. However, it may recur months or years later. Although a person who is otherwise healthy usually has his/her gallbladder removed, it may be better not to remove the gallbladder in someone who is not in good health, since acute cholecystitis is often an isolated event.
This is the most accurate test to detect and prevent cancer of the colon and rectum. Most people are advised to have a colonoscopy every 10 years, starting at age 50. Regular screenings can reduce death from colorectal cancer by about 50%. Colorectal cancer screening is an essential part of cancer prevention.
Problem: A study of Medicare patients who had a colonoscopy found that 46% repeated the test within seven years, and nearly half didn’t need a follow-up test that soon.
Colonoscopy is expensive, inconvenient—and sometimes risky. Its major complications are bleeding and perforations. Colonoscopy is technically considered surgery, since anesthesia is used and biopsies are often performed.
Who needs more frequent colonoscopies: Overall, about 30% of Americans over age 50 have colon polyps found during colonoscopy, with polyps coming in different types and sizes.
If you have had polyps, ask the doctor what size and type they were. People with a villous adenoma polyp or multiple and/or large tubular adenoma polyps have an increased risk of developing colon cancer and may need a colonoscopy every three to five years. Those with a parent, sibling or child who had colon cancer (or an adenomatous polyp before age 60) are screened every five years.
Who doesn’t need frequent colonoscopies: People without any polyps…with one or two small (less than 1 cm) tubular adenoma polyps…or with hyperplastic polyps in the descending colon or rectum are at no increased risk and can be screened every 10 years, unless they have other risk factors.
For people over age 75, the risk of routine colonoscopy outweighs its benefit and no further screening is indicated.
KIDNEY STONE REMOVAL
Many people with kidney stones never have symptoms. Symptoms generally occur when a stone migrates into the ureter, one of the two tubes that carry urine from the kidneys to the bladder. A “passing” stone can cause severe groin or side pain, blood in the urine, a burning sensation when urinating, nausea, vomiting and/or chills.
Problem: Doctors often recommend procedures to remove kidney stones that are causing no problems. Stones passing through the ureter will frequently pass on their own with medication, fluid and time.
Who does need kidney stone removal: People who develop an infection in the kidney from an obstructing ureteral stone. When the blockage is affecting the function of the kidney or the pain is severe and persists for more than two weeks, surgery is recommended.
Typically, the doctor will insert a tube via the urethra into the bladder and then thread a small instrument into the ureter until it reaches the stone. The stone can often be removed or repositioned to be broken up by shock waves (lithotripsy).
Stones in the kidney that are greater than 2 cm can usually be treated with lithotripsy. The procedure requires anesthetic but is done on an outpatient basis.
Who doesn’t need kidney stone removal: People whose stones are asymptomatic or those who have only occasional mild pain. Most stones less than 5 mm in diameter may hurt while they pass through the ureter, but they will pass (sometimes it takes weeks). I advise patients not to worry about asymptomatic stones and to give a ureteral stone, if appropriate, time to pass.
Future stone formation can often be prevented, depending on the type of kidney stone, by drinking lots of water, limiting sodium intake and taking medications if indicated by your doctor.
Source: Dennis Gottfried, MD, an internist with a private practice in Torrington, Connecticut, and an associate professor of medicine at the University of Connecticut School of Medicine in Farmington. He is also the author of Too Much Medicine: A Doctor’s Prescription for Better and More Affordable Health Care.