We’re such a surgery-loving society. More than 100 million operations are performed in the U.S. each year. The majority of them are optional, and up to 40 percent are unwarranted. One if five results in complications that include blood clots, hemorrhages, heart attacks, strokes, infections and death. For seniors, the rate is an astounding 43 percent.
And yet rather than seeking safer, often better alternatives, too many of us risk our lives for a quick fix; one that may fix nothing.
Whose Choice Is Surgery, Really?
A study in the medical journal Lancet found that about a third of Medicare patients 65 or older who died in 2008 had surgery during their last year of life; and most of the procedures were in their final month. Whether the operations were necessary or hastened the patients’ deaths couldn’t be determined, but the more hospital beds and Medicare funds a region had, the more surgeries and deaths occurred.
Researchers concluded that finances, not patient preferences or even medical necessity, might explain the increases.
Surgery makes good money for hospitals. They need to fill as many beds as possible to fill their coffers. Surgery also makes good business sense for surgeons. That’s what they’re paid to do, regardless of patient wants or needs.
But I don’t blame our zealousness for surgery on our medical system’s greed alone. Patients are part of the problem, too. I’m amazed at how cavalier so many seniors are about choosing surgery. Many of us opt to go under the knife to relieve pain or improve looks, rather than seek what may be more time-consuming and challenging – but ultimately more sustaining – alternatives. If the problem is painful joints, something that plagues most seniors, we head to surgeons rather than to rheumatologists, physical therapists, pharmacists or the gym. Overweight seniors undergo a tummy tuck or bariatric surgery rather than go on a serious diet.
Take one of the most common operations performed on seniors: arthroscopic knee surgery. Two of my friends recently had knee arthroscopy, and are neither is pain-free nor particularly happy with the results. Both needed extensive post-op physical therapy and still take pain medication. Had they tried physical therapy first, received the right meds and maybe lost some weight, they might have avoided surgery. The same principle applies to some cardiac stents and spinal fusions. AARP reported that because of their potential risks and poor success rates, these procedures are often unnecessary and best avoided.
Asking Questions Saves Lives
Patients need to research non-surgical options, and the risks and benefits of any procedure, and discuss these issues with their doctors. Of course, engaging surgeons in discussions about surgical risks and benefits – and also about patients’ preferences, needs and fears – can be challenging considering that most doctors lack training in communication. And many patients are too timid or intimidated to question their doctors’ recommendations or go for a second opinion.
Four in 100 seniors die each year from surgical complications. How can we save a few lives?
- Request second opinions. Almost a third of patients who get second opinions are told that the surgery is unnecessary. Few seniors get second opinions, but that may change, as more insurance companies now mandate them.
- Train doctors to encourage patients to seek second opinions.
- Pay doctors a salary, rather than a fee-for-service; this has been shown to significantly cut unnecessary surgeries.
It’s Up to Us
Still, it’s up to patients to take control of their own health care and make educated decisions. What really disturbs me is that so many of us are more likely to research the pros and cons of the latest smartphone than the pros and cons of a surgical procedure.
What’s a battery’s life compared to your own?