When to say no to surgery

When to say no to surgery Doctors used to routinely remove tonsils—until research found that the pain, risks, and costs of the procedure usually outweighed its benefits. Those days are gone, but research suggests that some people may still be getting surgeries they don’t need. Here, four procedures to question if your doctor pushes for them: Arthroscopic surgery to trim or remove a torn meniscus—the cartilage that cushions your knees—is the most common orthopedic surgery in the U.S. Rates for the surgery have increased 50 percent in the past 15 years, and about 700,000 are now done each year. But research shows that it’s often no better than physical therapy at easing symptoms. And in a New England Journal of Medicine study, patients who had “sham surgery” (in which surgeons made a small incision, then simulated the rest of the procedure) fared just as well as those who had the real deal. Other research shows that arthritis is more likely to develop in people who have the procedure than in those who don’t. Bottom line: If you’re suffering age-related knee pain and an MRI reveals a tear, first try rest, ice, a knee brace, over-the-­counter anti-inflammatory drugs, and physical therapy. (Read more about how choosing a hospital for knee surgery._ Blockages in your carotid arteries—which supply your brain with blood—increase the risk of stroke. So it would seem that surgery to clean out the ar­ter­ies, with a procedure called carotid endarterectomy (CEA), would be a good idea. Some doctors agree. They can detect problems by listening with a stethoscope to the blood in those arteries and, if they hear a worrisome sound, ordering an ultrasound. But if you’re 75 or older, the risks of the procedure—including heart attack and stroke—usually outweigh the benefits. That’s true even for younger people, unless they are at very high stroke risk. Yet research suggests that at least 20 percent of patients who undergo CEA aren’t good candidates. Bottom line: The procedure makes most sense for people ages 40 to 75 who have had a stroke or a mini-stroke, or are at very high risk. In other cases, ask whether medication and changes to your diet and exercise habits would be a better option. (Read more about choosing a hospital for heart surgery.) As we age, overgrowth of the bone surrounding the spinal canal can pinch nerves and cause a burning pain in your buttocks that radiates down your leg. A common treatment for that condition, called spinal stenosis, eases pressure by removing part of the bone and tissue. But many surgeons now combine that procedure, called lami­nec­tomy, with another one, called spinal fusion, which is meant to stabilize the spine. The number of fusion procedures jumped 67 percent among Medicare patients between 2001 and 2011. But for most people, there’s no evidence that adding fusion works better than performing lami­nec­tomy alone. Fusion also carries more risks and costs more. There’s a good chance, in fact, that you don’t need any surgery. In a study published in April 2015, patients who had physical therapy did as well as surgery patients. Bottom line: If you have spinal stenosis, try six to eight weeks of physical therapy before considering surgery. If surgery does become necessary, choose lami­nec­tomy, unless you have a slipped vertebra or scoliosis (curvature of the spine). (Read more about treating back pain.) New therapies, including progesterone IUDs and uterine artery embolization, have made hysterectomy less common as a treatment for uterine fibroids and the heavy bleeding those growths can cause. Still, about 18 percent of hysterectomies done for noncancerous reasons are un­necessary, according to a 2014 study. When it is needed, some surgeons still remove the uterus through a large abdominal incision, not vaginally, though that and other newer approaches are usually preferable. Bottom line: Make sure non-sur­gi­cal options have been considered. If you opt for hysterectomy, ask for a vag­inal or minimally invasive form of the ­procedure. (Read more about choosing a hospital for childbirth.) —Hallie Levine This article also appeared in the July 2015 issue of Consumer Reports on Health. Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

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