Unnecessary Operations - Every year, nearly 2.5 million people go under the knife unnecessarily, often with devastating consequences. Make sure you're not one of them.
by Catherine Guthrie
Two years ago, when Leah Coppersmith went in for back surgery, she expected to be lacing up her running shoes within days. She's been in pain ever since.
A car accident in 1991 left this mother of four with nagging lower-back pain annoying, but not bad enough to keep her from running 5-Ks. But in 2005, the nag grew to a scream.
An MRI revealed that two disks, the gel-filled cushions between the vertebrae, were badly worn. Coppersmith expected the doctor to recommend a diskectomy, in which part of a troublesome disk is removed to relieve pressure on the nerve; the low-risk surgery had helped her once before. But this time, the surgeon wanted to replace a disk with an artificial one. The procedure was getting great results, he said. Coppersmith was skeptical until he told her she'd be back running 5-Ks again in no time. She laughs bitterly at the memory.
Pain is now the defining feature of her life. She can't sit down to family dinners. She quit her job because she can't work at a desk. Her misery has company: While looking for help online, she found a study showing that 64% of people who received the disk, called the Charité, still needed narcotic painkillers 2 years after surgery.
Back pain is the commonest cause of loss of work among people under 45, with huge economic cost, but there is little incentive in the health service to apply resources to intensive retraining programmes for these patients.
Every year, upward of 15 million Americans go under the knife and for most of them, surgery provides relief or a new lease on life. Joints are replaced, organs are transplanted, lives are saved. But Congress has estimated that surgeons perform 2.4 million unnecessary surgeries a year in the United States, with a cost of roughly $3.9 billion and a toll of about 11,900 deaths. The reason isn't simple.
"The majority of surgeons who perform these procedures are actually very enthusiastic about their benefits," says Mark Chassin, MD, chair of the department of health policy at Mount Sinai School of Medicine. "It's not like they get up in the morning and ask themselves, How many unnecessary procedures can I do today? But there's a lot of financial incentive to do surgery that may not benefit the patient, and very little oversight."
So how do you know when someone is suggesting surgery you don't need and what can you do to prevent it? Your first line of defense is to become your own advocate. One study showed that when patients and doctors share the decision making, rates of surgery drop by as much as 44%. Here, we explain what's behind four of the procedures most often done unnecessarily and give you expert advice on the best alternatives.
The waiting room of Charles Rosen, MD, a spinal surgeon and an associate professor of orthopedic surgery at the University of California, Irvine, was filled with patients who, like Coppersmith, had failed disk implants. "In my 20 years of orthopedics, I'd never seen so many people in such a severe state of constant pain," he says. So Rosen examined the evidence backing the Charité disk. He was shocked to see that the researchers had compared patients who got the disk with those who received a type of fusion surgery with a particularly high failure rate 60%. (Even before the study's publication, that procedure had been largely abandoned.) Then he discovered that researchers on other Charité studies were paid consultants for the device maker. Outraged, Rosen founded the Association of Ethical Spine Surgeons. Members agree not to take money from device makers or form partnerships with the companies.
The spine is ground zero for unnecessary surgeries partly because back pain is incredibly common and notoriously tough to treat. More than 1 million sufferers opt for surgery each year, and spinal fusion the use of bone grafts, screws, and other devices to secure one or more vertebrae is one of the most popular choices. Between 1996 and 2001, the number of spinal fusions skyrocketed 113%, while the number of knee- and hip-replacement surgeries rose just 15% and 13%, respectively. But unlike those procedures, spinal surgeries often fail instead of relieving pain, they can turn it into agony. According to Aaron Filler, MD, PhD, director of the Peripheral Nerve Surgery Program, Institute for Spinal Disorders, at Cedars-Sinai Medical Center in Los Angeles, there are tremendous rewards for spinal surgeons who do aggressive procedures: Because of the hardware involved, an operation on the spine can pay a surgeon 10 times as much as one on the brain. Yet the money-making back surgeries help in only a small proportion of cases. What's more, back surgeons are rarely held accountable if the operation fails. "The referring doctor has low expectations," Filler says. "So does the patient, because everyone thinks of back problems as so difficult to treat."
Protect Yourself! Pinpoint the pain: If your doctor labels your back pain as "nonspecific", it means he doesn't know the cause; if he suggests surgery, alarm bells should go off, says Filler. Spinal fusion is most beneficial when vertebrae slip out of place and press on the ones below, which is easily detected on an x-ray. "When properly done for the right reasons, spinal surgery can be extremely effective," says Filler.
Make lifestyle adjustments: A 2003 study compared spinal fusion surgery with a lifestyle approach to back pain: Docs taught patients how to protect their backs, by bending at the knees when lifting, for instance. They also encouraged exercise, like water aerobics. A year later, the nonsurgical approach reduced pain and increased mobility just as much as surgery did. Alternative treatments such as chiropractic and acupuncture can also pay off, studies show. Click here for more information from Prevention.com on alternative treatments.
Consider a helpful shot: A nerve-blocking injection called an epidural, given by a surgeon or a rehab specialist like a physiatrist, may quiet the pain for up to a year; it helps in about 50% of patients.
Skip the hardware: If surgery seems like the right approach, get the simplest procedure possible. There's a much smaller chance of complications if you have a diskectomy, for example, than if you have an artificial disk implanted.
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