There is a great article in the July 9, 2014 issue of the Journal of the American Medical Association (JAMA) entitled, “Clinical Trial Evidence to Advance the Science of Cholecystectomy,” by Dr. Joseph S. Solomkin from the University of Cincinnati College of Medicine.
A Bit of Background:
Cholecystectomy is the medical term for the surgical removal of the gallbladder. The gallbladder is a several centimeter ‘bag’ that sit just underneath the liver and stores a digestive fluid called bile that helps dissolve the fat we eat. The gallbladder ‘bag’ stores the bile and the after a meal, it contracts and ‘squeezes’ the bile into the intestines to aid in digestion. The problem is that the bile can ‘congeal’ and form stones. These gallstones cause pain when the gallbladder contracts. People will often complain of chronic, worsening, intermittent upper abdominal pain on the right side especially after meals.
The treatment for symptomatic gallstones is surgical removal of the gallbladder—a Cholecystectomy. Believe it or not, you can live without your gallbladder just fine. Cholecystecomies are one of the most common surgical procedures and are usually performed on an outpatient basis either at a hospital or an ambulatory surgery center by a general surgeon.
Much Less Scientific Evidence in Surgery:
One would think that surgery—especially common surgeries like cholecystectomies—would undergo the same scientific rigor as other test and medications in healthcare. Surgery does not.
The above article by Dr. Solomkin begins as follows:
“Randomized trials evaluating drugs are frequently performed, both for purposes of initial regulatory approval and, after approval, to examine the utility of the drug in other clinical settings. No drug can get to market without being fully vetted. This is not the case for surgical procedures. Randomized controlled trials evaluating surgical interventions are uncommon, even for some of the most commonly performed operations.”
This particular article addresses the WAY the cholecystectomy is performed—should antibiotics be given after the procedure (turns out antibiotics after the surgery usually are not necessary) and should a certain test of the bile duct be performed before the surgery (turns out this test typically does not need to be done prior to surgery). In both these instances, rather rare, scientific studies were performed to evaluate how a cholecystectomy is performed and found that doctors where doing this that were not necessary—giving extra medication and performing extra tests.
Translation: Just because a surgery is ‘approved’ or even ‘common’ does not mean that it has been scientifically proven to be effective or more effective than non-surgical solutions. ‘That’s-just-the-way-surgeons-do-it’ does not mean that method has undergone scientific testing.
What does this mean for employee benefits professionals and healthcare consumers:
- Patients should always take the choice for surgery very seriously and consider a second opinion given the subjectivity on (1) whether or not surgery is the right thing to do and (2) the way the surgical procedure is performed.
- Employers and individuals are paying for surgical procedures that have not necessarily been scientifically proven to be effective. To Dr. Solomkin’s point, no medication would be allowed such a low bar.
- Greater employee education regarding non-emergency surgery and incentives to encourage second opinions may be helpful in improving healthcare quality and reducing healthcare waste.
At Compass, our Health Pro concierge helps facilitate that employee education and finding of a second opinion for our employer clients.