Unnecessary surgery

The concept of unnecessary surgery involves quantification of the necessity of a certain surgical operation and its deemed usefulness to the patient. This involves both eventual improvement of the patients' well- being by improved morbidity and mortality and justification of the outcome based on the expected costs including resources used and the cost of possible complications. Nevertheless, there is a lack of clarity since a myriad of reasons determine the need for and the outcome surgery at the core being individual determinants like tolerance to surgery. A surgery is unnecessary if it's ineffective or doesn't convey any benefit to the patient as opposed to an alternate less risky treatment option. This, therefore, means patients are subjected to unnecessary risk and increased chance of death. (Pauly 110)The financial costs are hefty resulting from investigations carried out, cost of the surgery, hospitalization, and treatment of complications.

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The menace of unnecessary surgery has emanated from various areas of healthcare. Firstly, there is conflicting evolving evidence and information on how procedures are performed creating a loophole that surgeons can use to navigate in such events. Inability or unwillingness of physicians and surgeons to accept or hold accountable colleagues who perform these operations. Advanced operation techniques have also contributed to this phenomenon; due to the quick nature of some surgeries, e.g. lumpectomy, surgeons end up recommending them instead of a more effective conservative treatment option. Furthermore, there is increased patient awareness on medical law hence out of fear of malpractice lawsuits, surgeons end up performing operations which have less medical value to simply satisfy the patient. Compensation policies of insurance companies have natured the need for more surgeries by capping high-value surgical operations or instituting limits of pay ultimately encouraging surgeons to operate more to meet their financial obligations within hospitals. Patient demands inadvertently contribute to these occurrences by demanding quick rather non-essential operations prompting surgeons to perform them.

Percutaneous Transluminal Coronary Angioplasty, a procedure performed to open up clogged or stenosed coronary blood vessels that supply blood to the heart tissue is a major culprit of this problem. The procedure is quite simple and is done by inserting a catheter through the femoral artery to the coronary vessels, and then a dye is injected to identify the narrowed area which is then a balloon is inflated to open up the area and allow the flow of blood. A stent, tiny metal, is then put in the expanded area to keep it patent. This is done as opposed to a more advanced open heart surgery as the alternative. A study found that more than one-quarter of patients who receive this procedure have to have a bypass surgery done in a few years or have the angioplasty procedure repeated less than two years later compared to a mere 5% of patients who underwent bypass surgery. (Leape 351)Additionally, these patients have to be on anti-thrombin medications to prevent the formation of deadly clots after the stents are put in place. The quick, less-invasive nature of this procedure makes it likely performed and unnecessary.

The surgeons, patients, and hospitals are the major stakeholders in evaluating and managing unnecessary surgeries. The burden of care lies with the professionals who perform these surgeries while the patients bear the risk of complications and repeat operations. The hospitals guide how the operations are carried out, the resource allocation to various operations and therefore directly affect how and why patient choose certain operations over others. (Stahel 980).Patients should have full information when making decisions which influence the necessity of certain operations hence patient education influences the occurrence of these mistakes. With the increase in technological advancements on certain surgeries, the law should evolve regarding the limits within which surgeons can recommend and perform operations to improve the legitimacy of medical lawsuits.

Development of standardized guidelines for patient care for the management of certain ailments or procedures to be followed for operations. Guidelines should be specific and detailed enough to distinguish them from expected or appropriate care of the patient. Operations that may require specific guidelines include surgeries that involve extensive utilization of human resource and finances, operations that are controversial or don't already have a specific technique or the methods are outdated and evolved, surgeries performed quite often and are overused, e.g. Heart surgeries and operations that have unpredictable complications. Guidelines should be specific, appropriate, all-inclusive, detailed and manageable. (Rutkow 675).Evaluation of the existing guidelines through evolvement of scientific information about certain surgical procedures should be done through a structured and intensive process guided by social values, practice experience, and scientific evidence. Despite a scarcity of surgical operations for which randomized clinical trials can be conducted, they are the gold standard for evaluation of these guidelines (Leape 375). The government, academic institutions, and professional surgical societies are responsible for coming up with and enforcing these guidelines. Hospital programs are to be the guardians of these policies for enforcement and review. Standard compensation and reimbursement policies for insurance providers can aid curb the need for unnecessary procedures to cover for hospital requirements. While it's critical to have guidelines, the credibility and acceptability to the adoption of these policies by surgeons depend on the status of the policymakers.

Works Cited

Pauly, Mark V. "What is unnecessary surgery?" The Milbank Memorial Fund Quarterly. Health and Society (1979): 95-117.

Leape, Lucian L. "Unnecessary surgery." Health Services Research 24.3 (1989): 351.

Leape, Lucian L. "Unnecessary surgery." Annual Review of Public Health 13.1 (1992): 363-383.

Rutkow, Ira M., and George D. Zuidema. "Unnecessary surgery": An update." Surgery 84.5 (1978): 671-678.

Stahel, Philip F., et al. "Wrong-site and wrong-patient procedures in the universal protocol era: analysis of a prospective database of physician self-reported occurrences." Archives of Surgery 145.10 (2010): 978-984.