How to Decide If You Need Surgery

You think you may need surgery. Perhaps your family healthcare provider has referred you to a surgeon or suggested that you have surgery. Maybe a friend had the same condition you do and had to have surgery, so you are afraid you will too. Don’t assume you need surgery; you may be able to return to good health without an invasive procedure.

A scalpel on surgical cloth
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There are situations where surgery is nearly impossible to avoid. If your appendix is inflamed and about to rupture, surgery is the only treatment. The same is true for badly broken bones and medical emergencies.

Steps to Decide Whether You Need Surgery

Outside of emergencies, most patients benefit from starting with the least invasive treatments and only having surgery as a last resort. An example would be a shoulder injury, the least invasive treatment would be anti-inflammatory drugs and pain medicine, then occupational or physical therapy with surgery as a last resort.

Meet With a Surgeon

If your surgeon recommends surgery for your condition, be sure to ask what treatments are available other than surgery. In some cases, the honest answer is that there are no other treatments. There are no medications that will repair a hernia, just as there is no exercise a physical therapist can teach that will fix a broken leg.

Seek a Second Opinion

If you are concerned that your original surgeon was too focused on surgery or did not provide alternatives, you may want a second opinion. The second surgeon may agree with the initial assessment and recommend surgery. However, there may be alternatives presented that make it worth your time and energy to seek out alternative treatments.

Consider Less Invasive Treatments

Investigate treatments that may work as well as surgery, but don’t require hospitalization. An example of this would be a coronary stent, a device that opens blocked arteries near the heart. Stents, like a heart bypass surgery, are effective in treating some patients with coronary artery disease. For patients who are candidates for stents, the less involved procedure may be a good alternative.

Not all surgeries have a less invasive counterpart, but many do. In addition, many surgeries that once required large incisions, extended healing times or days of recovery in a hospital are now done with more advanced techniques that allow them to be done on an outpatient basis.

Medication Therapy

In some cases, medication therapy can be very effective for treatment of pain and inflammation. NSAIDS, or anti-inflammatory medications like Ibuprofen, can reduce swelling and allow healing. Pain medication may also be prescribed for pain reduction.

Physical or Occupational Therapy

With these types of therapies, specially targeted exercises are used to strengthen muscles, rebuild strength and regain mobility. A patient with back pain may use a combination of pain medications and physical therapy to build strength and flexibility and regain full use of their back and avoid surgery.

Occupational therapy uses the same techniques along with exercises specifically designed to help people with tasks they perform at work and home. For example, a patient with a shoulder injury whose job requires heavy lifting might meet with an occupational therapist to regain the ability to lift boxes. The therapy would also include new techniques to make it possible to work without reinjuring the shoulder.

Changes in Diet and Lifestyle

Your healthcare provider may tell you that you can avoid surgery with serious changes in diet and lifestyle. He may suggest a reduced-fat diet, a low cholesterol diet or any number of changes in nutrition. Major changes in diet can produce many positive results.

Proper nutrition can reduce blood sugar, blood pressure, improve coronary artery disease, and decrease the workload of organs. A visit with a nutritionist may be necessary to explore the necessary diet changes. In some cases, diet can eliminate the need for surgery entirely.

Exercise, if your healthcare provider recommends it, can produce just as many beneficial results. Be sure not to overdo it and make sure your healthcare provider says it is safe. Exercise does not have to be strenuous to be beneficial. Water aerobics, walking and other low impact forms of exercise can have tremendous benefits without causing added stress on the body.

Why You May Need Surgery

There will be situations where medications, physical therapy, and lifestyle changes don’t change your level of pain or fix your condition. If you’ve given the non-surgical therapies a chance without success, it may be time to consider surgery.

Your quality of life is an excellent guide for deciding whether or not to have surgery. Pain can be a good indication of whether or not to proceed. If you have daily pain that would be relieved permanently by surgery, your general quality of life would be greatly improved. If you cannot currently participate in your favorite activities but would be able to after surgery, having the procedure becomes a more attractive option.

Deciding Whether to Have Surgery Now or Later

In some cases, surgery can be delayed but remains necessary in the long run. An example would be a knee replacement procedure that is not absolutely necessary today but will become necessary in five to ten years. Medications may ease the pain now, allowing the surgery to be postponed for a few years, but not indefinitely.

Delaying surgery may or may not be a good plan. If you are seventy years old and in good health, your chances of having a successful surgery and recovery will be better now than they will be when you are eighty, even if you remain in good health. The older the patient, the more risk there is with any surgery, regardless of the type.

There are many reasons that an individual might want to delay surgery temporarily. They may be switching jobs and insurance plans, or they may have a major event in the coming weeks that will make recovering more difficult. Whatever the reason, discuss the delay, and if it will cause more harm than good, with your surgeon.

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  • Booklet of Information-Surgery. The American Board of Surgery, Inc. 2007.

  • Having Surgery? What You Need to Know, Questions to Ask Your Doctor and Your Surgeon. October 2005. The Agency for Healthcare Research and Quality.

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.