When your doctor recommends that you have an elective procedure, it’s important to gather information before you say yes.
Orly Avitzur, Consumer Reports’ medical director, says you should ask your doctor (or the surgeon you’re considering) to explain the details of the procedure; why he or she thinks you need it; the benefits and possible risks; the alternatives; and what may happen if you don’t have the surgery. You’ll also want to know what your costs may be, what anesthesia will be used and whether the procedure will be done on an inpatient or outpatient basis.
There are a few other questions you may not think of, however. And getting the right answers may reduce the likelihood of pre-op and post-op problems.
You’ll want to know that the surgeon has recent and significant experience with the procedure you’re going to have. Research has found that the more often a surgeon has done a particular procedure, the lower the risk of complications or even death for the patient.
There’s no magic number. When it comes to hip or knee replacements, for example, you ideally want a surgeon who has done at least 50 in the previous year, with a complication rate of 3 percent or less. (A study published in 2017 that looked at laparoscopic hysterectomies found that there may be a learning curve for the first 100 procedures.)
If you aren’t satisfied with what the surgeon tells you, ask your internist to recommend another surgeon.
About 650,000 people develop an infection while in a hospital each year, most commonly pneumonia and surgical-site infections. Because many surgeons have operating privileges at multiple hospitals, you may be able to choose the facility you prefer. Your surgeon may be unable to provide infection-rate information, but you can go to cr.org/hospital-ratings to find out how Consumer Reports rates your hospital on the prevention of five types of infections, along with other measures of patient safety.
X-rays, blood tests, stress tests: Getting ready for a scheduled procedure can take longer than recovering from the operation itself. People with certain medical conditions need preoperative tests to make sure that they’re in good enough physical condition for surgery. The practice has been broadly adopted for healthy patients, too, although studies have found that it’s unnecessary.
You probably don’t need a chest X-ray unless you’re a smoker, you have symptoms or a history of heart or lung disease, or you’re having major surgery, especially in the chest or upper abdomen. Blood tests aren’t needed if you’re undergoing an elective procedure that’s considered to be low-risk, such as cataract surgery.
Having a heart stress test may also be unnecessary. Seven medical specialty societies, including the American College of Cardiology, advise against pre-op stress testing for people scheduled to undergo low- or intermediate-risk noncardiac surgery, such as those above.
You probably already know it’s important to make sure your primary surgeon accepts your health insurance. But other providers who aren’t in your insurance network may become involved in your care during and after a procedure.
These are often providers you have no role in selecting, such as assistant surgeons, anesthesiologists, pathologists who review your biopsy and radiologists who read your imaging test results. Out-of-network consulting specialists may be able to bill you separately and charge a much higher rate than those who contract with your health insurer.
Although more than 20 states are working toward or have already enacted protective measures, millions of people are still vulnerable to surprise medical bills.
Ask your surgeon to make sure those involved in your care are in your network. He or she can take this into consideration when selecting a surgical team. Before you’re admitted to a hospital, ask whether pathology and radiology providers are in your network. (For advice on how to fight a troublesome bill, go to cr.org/surprisemedbills.)
For further guidance, go to ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.