Patients Often Aren’t Offered Minimally Invasive Surgery

It would be nice to think that when you go in for surgery you’d be offered the safest, cheapest alternative, but that’s not always the case, a study finds.

Some hospitals are much more likely than others to offer minimally invasive surgery for procedures like colon or lung surgery or appendectomy, according to an analysis published Wednesday in JAMA Surgery.

And that means a higher risk of complications and greater expense, the study found. It looked at 80,000 surgeries in the 2010 National Inpatient Sample, and found that people who had minimally invasive surgery stayed in the hospital about 1.4 days less.

Minimally invasive surgery reduced the number of complications and saved money, too: a mean of $1,528 for appendectomy; $7,507 for cholectomy; and $6,290 for lobectomy. Between 44 and 68 percent of the savings came in reduced medical complications.

“It’s hard to justify why anyone’s spending an additional $3,000 for something as simple as taking out a gall bladder, which is so simple and has been perfected with minimally invasive surgery.”

Since these surgeries are so common, if all hospitals used minimally invasive surgery as often as the top one third of hospitals they would avoid 4,306 complications and 169,819 days in the hospital, and save $337 million a year.

“We found there were massively divergent rates of adoption,” Dr. Martin Makary, a professor of surgery at Johns Hopkins University Medical Center and lead author of the study, told Shots. “I think it’s one of the greatest disparities in American medicine.”

The method, also called laparoscopic surgery, involves sticking miniature cameras and tools into the abdomen through very small incisions. Done right it’s much less traumatic than open surgery that cuts through abdominal muscles and organs. The first laparascopic appendectomy was done in 1981, and the technique has since become common for many other surgeries, including hysterectomy and gall bladder removal.

Not every surgeon is skilled in minimally invasive surgery, Makary says, and not every patient should get it, especially if the person is very sick or has had lots of surgery. “We do a good job of triaging patients in the emergency room, but we don’t do a very good job of triaging patients for surgery.”

One reason may be that people are usually referred to a surgeon by their doctor, and that surgeon may or may not do minimally invasive surgery. But patients should ask if they are good candidates, Makary says, and ask for a second opinion if it’s not being offered.

The numbers in this study also include robotic surgery, a form of minimally invasive surgery that has been heavily promoted by hospitals, despite the lack of evidence that it doesn’t improve outcomes for most surgeries.