for the patient
for the practitioner
Your specialist has recommended an operation: Is it really necessary? what are the benefits? what are the risks involved? are there no valid alternatives? A dilemma for many patients.
How can I make a decision together with my practitioner?
Ask for a qualified and independent second opinion through ISOM
Recent publications have indicated that a significant percentage of orthopaedic procedures are not justified on the basis of randomised controlled clinical trials (26,39).
For example:
– There is no convincing evidence that surgical treatment for subacromial pain syndrome of the shoulder (SAPS) is more effective than conservative management and is, moreover, susceptible to peri-operative complications (3,41,42). According to the guidelines of the dutch orthopaedic society it is preferable to treat SAPS non-operatively.(42).
– The same guidelines foresee no indication for the surgical treatment of asymptomatic rotator cuff tears (42).
– Multiple randomised clinical trials have shown that the fusion of two or more vertebrae for the treatment of back pain does not lead to improved long-term patient outcomes when compared to non-operative treatment. (5,24,38,50). Furthermore, there is insufficient evidence for the incremental benefit of vertebral fusion in addition to laminectomy for spinal stenosis. (10)
Hear what our expert has to say before taking a decision on whether to proceed with the operation.
Is the surgery that has been proposed for your patient really necessary? This is a question that you, as a practitioner, are often faced with.
According to an international study performed by OECD, Switzerland performs more surgical operations per 100’000 population than most of the other industrialised countries. They conclude that “often the determining factors are not those of the patient’s well being” (45,46).
According to statistics published by the Swiss Federal Office of Public Health (FOPH), from 2003 to 2014 this number has increased by as much as 145%, five times that of the demographic growth. (45).
Many indications do not require surgery or, at least, not immediate surgery. For example, multicentre randomised clinical trials (6,17,47,48) on patients with meniscal tears and evidence of mild-to-moderate knee osteoarthritis, showed no significant differences in the improvement of functional status and pain after 6 and 12 months between patients assigned to arthroscopic partial meniscectomy and patients assigned to a standardised physiotherapy regimen alone.
Please see also the studies regarding subacromial pain syndrome and those for back pain reported here alongside.
Is your patient in doubt as to whether to proceed with an operation? Speak with him or her and
request a second opinion through ISOM.
An expert in the specific field will evaluate the indications for surgery on a personalised basis bearing in mind the most up-to-date guidelines.
