[Here’s something that might come up in the discussion about “The R Word” that SLHI is hosting on September 25. If you have an interest in the topic, you are welcome and encouraged to attend. Register on the ArizonaHealthFutures site.]
Unlike prescription drugs, surgeries often become widely used before they are tested for long-term effectiveness. As a result, over the past two decades millions (500,000 annually) of coronary bypass surgeries were performed in very expensive cardiac operating suites built by hospitals anxious to lure in the best surgeons. Each surgery costs more than $50,000 and most were paid for by insurance. Recoveries were long and painful, and patients often suffered from depression after the surgery. Only recently has it come to light that these surgeries did not produce better overall outcomes than medical intervention (non-surgical treatments like prescription drugs, exercise, and diet therapy).
Now another study has shown that vertebroplasty, a minimally invasive surgery in which an interventional radiologist injects cement into spine, is no better than a placebo surgery. According to a report in the Boston Globe, this surgery is no more effective than more conservative treatments.
In … two new studies – one conducted in the United States, the other in Australia – all patients were injected with the same local anesthetic, but those in the control group received no incision or cement injection. Instead, doctors tapped on their numbed backs, simulating a cutting action, while cement was mixed in the operating room so the procedure smelled authentic. The American study followed 131 patients for one month after surgery, while the Australians enrolled 78 patients and monitored 71 of them for up to six months.
Even some of the surgeons who conducted the studies were surprised at the results.
Now doctors who perform vertebroplasty are trying another study:
Since completing their study, Cloft said, he and his colleagues have become more conservative in offering vertebroplasty and suggest patients first try what is, in essence, the sham surgery – injecting anesthetic, but no cement, into the back. The Mayo Clinic study noted that the half-life of the local anesthetic used in the surgery (sham and real) is only 3 hours, meaning it is unlikely that the drug would have long-lasting pain-relief effects. They are tracking the outcome
Last year, there was another upheaval in the surgical world when studies of comparative effectiveness showed that knee surgery to relieve the pain of arthritis was no better than a sham surgery.
Why is this important? Because surgery has become the most expensive part of medicine, and Americans are used to the “surgical fix.” Perhaps they have even become mentally conditioned to expect relief from the surgery and therefore they experience it and report themselves as satisfied to their doctors. But surgery is 1) potentially risky, and 2) expensive for the entire society. Every surgery performed unnecessarily drives up health care costs and taxes the system further.
So when you hear people talk about “rationing,” and about how people in other countries with national health systems don’t get to see as many specialists or have their operations as quickly as Americans, ask yourself this question: “are these surgeries really necessary?” That’s what insurers are asking right now about vertebroplasty.