Are some operations unnecessary?

A leading surgeon, Prof Andy Carr, of the respected Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences says that many types of surgery might be pointless.

A recent study has shown that there was no significant benefit for patients who underwent procedures such as:-

• Knee replacement for arthritic knee
• spinal cement injections for vertebral fractures
• some gastric balloon procedures for obesity
• certain forms of endometriosis surgery

When compared with the placebo effect the study showed that there did not appear to be any noticeable benefit to the patient.

Professor Carr said “The correct thing has got to be to do the trials – not to continue doing operations where we don’t know whether or not there’s a strong placebo component or an entire placebo component because that means that tens or hundreds of thousands of patients are having unnecessary operations.”

A forthcoming shoulder surgery trial will look at a procedure called an acromioplasty. In this type of keyhole procedure, a spur of bone in the shoulder is shaved off. The purpose of the operation is to remove the bone spur which is thought to cause pain when tendons rub against it.

This operation is performed 10,000 times per year in the UK, but a study reporting its actual efficacy is due to be published next month. This could be another operation to add to the list of questionable procedures.

Patients often see an operation as a last chance to cure a particular condition. Surgeons naturally want to be helpful to their patients and will offer the surgery that medical science thinks will work. However, it may well be the case that operating (due to unexpected complications) can cause more harm than good.

Operating on a patient also raises expectations of a cure for a particular condition when in fact the surgery may offer no solution to the patient’s condition at all. This resultant failure may cause the patient to be more distressed than before.

From a medical ethics viewpoint can it be said that informed consent being properly obtained for surgery that has a questionable success rate?

Professor Carr has opened up an interesting debate as to what surgery actually achieves and how “successful surgery” should be measured.

It may be the case that some types of surgery should be discontinued altogether and this might free up resources for treatment that can be proved to work.