Rate High on Unneeded Surgeries

One out of every three operations designed to open clogged arteries in the neck is unnecessary and specialists in the procedure are among those most likely to operate inappropriately, Dr. Robert Brook and his colleagues at the RAND Corp. in Santa Monica reported last week in the New England Journal of Medicine.

In a study of Medicare records, they found that when patients were operated on by doctors who did not specialize in the neck operation, surgery was clearly needed in 40% of the cases. Yet when the patient underwent surgery by a surgeon specializing in endarterectomies, the operation was clearly necessary only 28% of the time.

The researchers found that the trend extended to other medical procedures as well. They found that 17% of both coronary angiographies (a procedure in which a tube is sent into the heart to look for heart disease) and upper gastrointestinal endoscopies (where a tube is put down the throat to look for ulcers, tumors and other problems) were unnecessary.

Ironically, health experts encourage people who need medical treatment to seek out specialists in the belief that doctors who frequently perform a particular type of operation or test will do a better job. “High-volume physicians may perform a procedure better but the patient may have been less likely to need it in the first place,” the Brook team concluded.