Two stories which highlight a medical truth: There's no such thing as minor surgery.

Two stories caught my attention recently which unfortunately demonstrate the truth behind a classic quote you’ll sometimes hear in the halls of medicine: “There is no such thing as a minor surgery.”

The first was a story in the New York Times about vascular surgeons who have apparently made a habit of over-selling the benefits and under-selling the risks of atherectomies. These “minimally invasive surgical procedures” are meant to remove plaques from arteries, similar to ones that can cause heart attacks when found in coronary vessels. Terrible things happened, including the amputation of limbs which were probably never in danger beforehand. It’s nauseating to think of physicians putting profit over their patients’ own safety. And while I doubt many of these doctors realize this is what they did in some cases, on some level, that’s exactly what they appear to have been doing.

Lake Wobegon Hospital…

Too often, I see patients who had some elective procedure that leads to a complication that they didn’t anticipate—but the medical literature did. Sure, their surgeon was legally bound to discuss the risks and benefits of a procedure.

But how they did that is the rub. The Lake Wobegon Effect is real in medicine, and for surgery in particular. "Serious complication rates from this procedure are around 5%,” a doctor might tell a patient, “But in our practice, the rates are even lower.”

Well, not everyone can be above average, can they?

As an ER doctor, I see these complications. Some of these are rare and unavoidable events which I happen to see because rare things end up being common in ERs attached to major academic centers. I’ve also seen a few too many botched plastic surgeries done overseas or in the proverbial “mini-mall surgical center.”

Which leads to the second story: the death of Lisa Marie Presley. Presley did not have what anyone would call a minor surgery. She had bariatric surgery (likely a gastric bypass, but I’m not certain) in order to achieve weight loss. The complication that caused her death—a blockage or obstruction of the small intestine—is a known risk. In fact, the most common cause of a small bowel obstruction is adhesions caused by a prior surgery, which occurs when bands of scar tissue from the intestines stick together and can’t come apart. From there, the intestines can die (enough dead tissue in the GI tract can be lethal), or become infected and burst causing a massive systemic infection and/or sepsis. (Other common causes are tumors and internal hernias, though the latter are often caused by prior surgeries too).

Presley was probably told by her surgeon that the death rate from her surgery was 1% or less. That may have been right. But it was not 0%. Was the risk of death (whatever it really was) worth it? In addition, she apparently did not seek medical attention, despite months of symptoms. This comports with intermittent obstructions which became permanent, likely very soon before she died. This leads to another key point: if you don’t feel well, seek medical attention. There’s no prize for toughing out a small bowel obstruction.

Of course, none of this means that patients should never have surgery—even “elective ones.” But it should never be forgotten that every medical procedure has risks and benefits. There’s no such thing as a risk-free procedure.

What to ask your doctor before any procedure:

If it were me, I’d ask my potential surgeon more than the just the rate of serious complications. I’d specifically ask “Have you ever seen one of these cases go badly?” From there, I’d ask how and why things went south, and what the end results were. I’d ask what caused the complications; sometimes it’s the patient’s own frailty (which can’t be helped) and other times it’s just bad luck or a mistake (which a surgeon is unlikely to admit—though I’d respect them for admitting that they are human if they did).

Please chime in. Have you encountered a situation in which the outcome of a medical procedure was “different than described?” If you’re comfortable sharing your story, please do so in the comments section below…