A Patient’s Guide to Unnecessary Surgery

Unnecessary surgeries occur more often than many realize, leading to avoidable pain, financial costs, and prolonged recovery times for patients. Studies reveal that up to 10-20% of all surgical procedures may be medically unnecessary, especially in fields like orthopedic surgery, spinal procedures, and heart surgeries. This guide will explore why unnecessary surgeries happen, how to question recommendations, and what patients can do to protect themselves.

Why Doctors Sometimes Misinform You

Though most physicians prioritize patient welfare, a combination of external pressures and biases can sometimes lead to unnecessary surgical recommendations. Factors include:

• Financial Incentives: In some healthcare systems, physicians or hospitals are financially rewarded for performing more procedures. Studies suggest this financial pressure increases surgery rates by as much as 15-20% in some specialties.

• Medical Culture: Certain medical cultures emphasize interventional over conservative treatment, even when less invasive options may be just as effective. For example, while many back problems can improve with physical therapy, spinal fusion surgeries are common, despite only having a 50% success rate for long-term pain relief.

• Overconfidence in Surgery: Surgeons may genuinely believe in the benefits of their recommended procedures, despite recent studies challenging their efficacy. This can lead to "overconfidence bias," where a surgeon’s belief in their skill and training overshadows a thorough evaluation of all patient options.

The Misleading MRI

Magnetic Resonance Imaging (MRI) is widely used for diagnosing musculoskeletal issues, yet it’s not always a reliable indicator for surgery.

• Over-interpretation of MRI Results: Studies show that up to 70% of asymptomatic people (people with no pain or functional issues) have MRI abnormalities that could be mistaken for injury or disease. When MRIs are used as a primary diagnostic tool, they can lead to unnecessary surgeries, especially for spinal and knee procedures.

• False Positives: MRIs can show harmless abnormalities, like disc bulges, that don’t cause symptoms. One study found that 30-40% of back surgeries based on MRI findings alone could have been avoided.

• Lack of Correlation with Symptoms: An MRI abnormality does not always correlate with pain or functional limitation, meaning that some procedures based on MRI findings may fail to resolve a patient's actual issues.

How to Protect Yourself: A Patient’s Checklist

1. Ask About Alternative Treatments

• Ask if non-surgical options, such as physical therapy, injections, or lifestyle changes, might be effective. Studies have shown that up to 80% of people with chronic back pain find relief through physical therapy and other non-surgical treatments.

2. Seek a Second Opinion

• A second opinion from an independent surgeon can offer new perspectives. Research shows that getting a second opinion can reduce unnecessary surgeries by up to 25% in some cases.

3. Question the Role of Imaging

• Ask if your symptoms correlate directly with the imaging findings. Consider delaying surgery if the only recommendation is based solely on an MRI result.

4. Look into Your Surgeon’s Track Record

• Some surgeons may be more inclined to operate than others. Check if your surgeon has a higher-than-average rate of certain procedures and explore the reasons behind this.

When Surgery May Be Necessary

While unnecessary surgeries are a concern, certain situations do demand surgical intervention:

• Loss of Function or Worsening Symptoms: When symptoms worsen despite conservative treatments, surgery may be the best option.

• Emergency Situations: Certain conditions, such as a severely fractured bone or life-threatening cardiac conditions, do require urgent surgical care.

• Failed Conservative Treatments: If symptoms persist after trying all non-invasive options, surgery might be appropriate.

Why Surgery Alone Isn’t Enough: The Essential Role of Rehabilitation and Exercise

For many musculoskeletal conditions, surgery is not a standalone solution. Research consistently shows that rehabilitation and exercise are necessary both for pre- and post-surgical recovery to restore function and prevent further injury. Studies reveal that physical therapy can be as effective as surgery for conditions like degenerative disc disease and meniscal tears. Furthermore, a comprehensive rehabilitation program improves surgical outcomes, helping maintain strength, mobility, and stability.

The Reality of Surgery and Recovery

• Surgery as a Last Resort: Surgery should not be seen as a quick fix or immediate solution. Multiple studies highlight that, in many cases, conservative treatments, such as physical therapy and strength training, are as effective as surgery, especially for knee, hip, and back issues.

• Post-Surgery Rehabilitative Needs: Even after surgery, recovery isn’t complete without dedicated rehabilitation. For example, a 2018 study on knee surgeries found that 80% of patients required long-term physical therapy to regain strength and mobility fully. Without it, the risk of complications, re-injury, or chronic pain increases.

The Benefits of Prehabilitation

Pre-surgical exercise programs, known as “prehabilitation,” have been shown to improve post-surgery outcomes. Patients who undergo structured exercises before surgery tend to recover faster, regain strength more quickly, and experience less pain.

In summary, whether or not surgery is pursued, rehabilitation and exercise are vital for restoring function, managing pain, and ensuring long-term musculoskeletal health.