Post by Joanna on Jan 21, 2014 22:13:44 GMT -5
4 Surgeries to Avoid
Any surgery is dangerous. The body considers an operation a serious insult, and even some minor procedures come with major risks, such as bleeding, blood clots, infections, and damage to other organs. So it's essential to know if surgery is necessary – or beneficial.
The four operations discussed here are over-performed for a variety of reasons: Some are moneymakers for hospitals and doctors, others are expedient, and still others seem to work, at least in the short term. But evidence shows that all have questionable long-term outcomes for treating certain conditions, and some may even cause harm. Here's what to do if your doctor recommends one of them.
1. Stents for Stable Angina. Stents are tiny mesh tubes that surgeons use to prop open arteries carrying blood to the heart. If a patient is having a heart attack, a stent can be a lifesaver. But for heart disease patients with stable angina – chest pain brought on by exertion or stress – a stent is not better at preventing a heart attack or prolonging survival than lifestyle changes such as exercising and taking statins to lower cholesterol, according to a landmark 2007 Department of Veterans Affairs study.
Despite stents' ineffectiveness, close to 500,000 are implanted each year for stable chest pain, says Sanjay Kaul, M.D., a cardiologist at Cedars-Sinai Heart Institute in Los Angeles. Surgeons frequently insert the stents during heart-catheterization procedures to evaluate patients' blood vessels, says Lee Lucas, Ph.D., an epidemiologist at Maine Medical Center Research Institute, who argues that the catheterization should be done first as a diagnostic test, and stenting done later, if necessary. "This should be a two-stage procedure, but patients never get to leave the cath lab to think about it," says Lucas.
Alternatives to Surgery. If your doctor orders a heart catheterization, ask that he or she wait to perform any treatment such as stenting in a separate procedure. Even before submitting to a heart cath, make sure you've explored other alternatives. Have you had a stress test? Do you adhere to a strict diet, exercise, or take medications to manage your cholesterol? "The reality is that 20 percent of patients who undergo this [catheterization with stents] do not have any symptoms, 30 to 50 percent have not had a stress test, and 30 percent are not treated with medical therapy first," says Kaul. If plaque is forming in your arteries, this is a systemic disease; a stent won't keep even a full inch of your arteries clear. You'll still need aggressive medical therapy to prevent future problems.
2. Complex Spinal Fusion for Stenosis. With spinal fusion, a surgeon places bone grafts that "weld" two or more vertebrae together to prevent motion and stop pain. The procedure is often used to treat back pain from spinal stenosis, which occurs when the soft tissues between the vertebrae flatten out, creating pressure on the spinal cord or nerves that go to the back, arms, neck, shoulders, and legs. There is little consensus on how best to relieve pain from stenosis, so doctors tend to develop their own preferences, says Richard Deyo, M.D., professor of medicine at Oregon Health and Science University.
Their top treatment choice increasingly seems to be fusion. Deyo recently studied the records of more than 30,000 Medicare patients who underwent surgery for stenosis of the lower back and found that complex fusion procedures (in which surgeons place bone grafts between multiple vertebrae) had increased an astounding 1,400 percent between 2002 and 2007.
The risks are significant: Those who underwent complex fusion were nearly three times more likely to suffer life-threatening complications than those who underwent less invasive surgery. Previous studies have also found that most fusion patients experience no more relief from their chronic back pain than those who had physical and behavioral therapy. "There is even some evidence that [complex fusion surgery] is worse than other surgeries," says Floyd J. Fowler Jr., Ph.D., senior scientific advisor for the Foundation for Informed Medical Decision Making (FIMDM). "The vertebrae right above and below the fusion have to do a lot more bending, and it puts stress on your back above and below."
Alternatives to Surgery. Before considering any type of back surgery, make sure you have exhausted more conservative measures, including physical therapy, cortisone injections, acupuncture, and medications. "Probably less than 5 percent of all back pain requires surgery," says Arnold Weil, M.D., clinical assistant professor of rehabilitation medicine at Emory University School of Medicine in Atlanta.
3. Hysterectomy for Uterine Fibroids. Each year approximately 600,000 American women have hysterectomies, or removal of the uterus, and studies show that the vast majority are unnecessary. A hysterectomy is critical when the patient has cancer (which is the case for about 10 percent of those women). But most patients undergo the procedure for quality-of-life concerns such as heavy bleeding or pain caused by uterine fibroids – benign growths in the uterine wall.
Complications are common. Women who undergo a hysterectomy have a 60 percent increased risk of incontinence by age 60, a University of California, San Francisco study found. A hysterectomy that includes removal of the ovaries – an oophorectomy – throws the patient into instant menopause. These patients also face a higher risk of heart disease and lung cancer, says William Parker, M.D., author of A Gynecologist's Second Opinion and lead investigator of a 2009 study on the long-term health consequences of hysterectomy.
Alternatives to surgery. If you suffer from uterine fibroids, ask your doctor about other options, including uterine-artery embolization, in which the arteries leading to the uterus are blocked, causing the fibroids to stop growing. You might also consider a new procedure, focused ultrasound, which shrinks fibroids via ultrasound waves. "It's kind of amazing that we've had all these alternative procedures for many years and they haven't gained a lot of traction," says Parker.
4. Knee Arthroscopy for Osteoarthritis. With this procedure a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscal tissue, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee. In a 2008 study, 178 patients with osteoarthritis received either physical and medical therapy without surgery, or therapy plus surgery. After two years the two groups had nearly identical outcomes, reporting less pain and stiffness and more mobility.
Alternatives to surgery. If you have knee pain, "start with the least harmful and invasive treatment and work your way up the ladder," says Colin Nelson, a senior research associate at FIMDM. This includes lifestyle changes such as exercise, as well as medication and cortisone injections.
Source: Karen Cheney, AARP Magazine.
