By Peter Eisler, USATODAY
Here are six common surgeries that carry significant risks of being done without medical necessity, according to federal data and independent studies.
Cardiac angioplasty, stents:
A 2011 study in the Journal of the American Medical Association looked at angioplasty procedures, which often include insertion of stents. In cases where patients were not suffering acute heart attack symptoms, 12% of all angioplasty procedures were found to lack medical necessity.
"This procedure (angioplasty), along with stenting, has been proved to protect the heart or prolong life only in people highly susceptible to heart attack," Consumer Reports wrote in 2005. "In everyone else, it appears only to ease angina. Further, the procedure has risks, including, in two to six percent of patients, heart attack, stroke or death."
A 2011 study in the Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support the installation.
A 1988 study in the New England Journal of Medicine reviewed 382 pacemaker implants at 30 Philadelphia-area hospitals and found that 20% of the procedures were not medically warranted.
Back surgery, spinal fusion:
A 2011 study, in the journal Surgical Neurology International, assessed the medical records of 274 patients who were told they needed spinal surgery. More than 17% had no abnormal neurological or radiographic findings in their case histories.
"Since the 1980s, operations for low-back pain have increased from about 190,000 to more than 300,000 per year," Consumer Reports noted in 2005. "Many of those operations are probably unnecessary."
Hysterectomy (surgical removal of the uterus):
In a 2000 study for the American College of Obstetricians and Gynecologists, researchers assessed hysterectomies on 497 women in Southern California. They found the surgery was recommended inappropriately in about 70% of cases, often because doctors did not try non-surgical approaches.
"The conditions that most often cause pelvic pain or abnormal bleeding - fibroids, or benign tumors; endometriosis, or growth of uterine-like tissue on abdominal or pelvic organs; and hormonal imbalances - can all be treated less aggressively," Consumer Reports reported. Other potential options: therapy to reduce estrogen levels or surgery to remove fibroids but retain the uterus.
Knee and hip replacement:
In a 2012 study in Health Affairs, researchers provided patients in a Washington state health system with "decision aids," which included information on joint replacements and alternative treatments. The researchers found that patients who got the information had 26% fewer hip replacements and 38% fewer knee replacements.
In a 2013 study in Health Affairs using data from 593 hospitals nationwide, researchers found that cesarean rates varied tenfold across hospitals, from 7.1% to 69.9%. Among women with lower-risk pregnancies, where researchers expected less variation, cesarean rates varied by a factor of 15, from 2.4% to 36.5%. "Vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many U.S. hospitals," the study concluded.