Chapter 14: How To Decide If Surgery Is Your Best Option

Plus is this the right surgeon and hospital for you?

Photo by National Cancer Institute on Unsplash

I recently refused to have one surgery and delayed two others. I’m not anti-surgery; I’m anti-unnecessary surgery. I’m cautious because I’ve already lived through a breast cancer misdiagnosis leading to an unneeded lumpectomy in 2006. Two of the four surgeons I met with wanted to remove my cancer-free left breast (mastectomy). I chose based on my gut and my family’s mantra of no surgery without a second opinion. Yes, the surgery was time-consuming and emotionally triggering. But luckily, I avoided the emotional devastation of an unneeded mastectomy.

Now, I’m a better educated patient. And you can be, too. Using many of the steps below, I realized all three of the recommended surgeries could wait. Unless you’re in the midst of a life-threatening medical crisis (and why are you reading me if you’re in the midst of an emergency?), you have the benefit of time to get educated and make an actual decision.

All surgery is risky. There’s really no such thing as a completely safe surgery. Once you break through the skin, you face risks like infection, nerve damage, pain, blood clots, bad reactions to anesthesia and surgical errors. Almost half of patients having surgery experience them, one in three experience other types of medical harm while hospitalized, and over half of these adverse events are preventable.

Yet, surgery saves lives. It’s the best option when the existing alternative treatments have failed and your symptoms –– i.e., your pain, your inability to move or breathe freely, the threats to life and limb –– exceed the risks. In progressive diseases –– like cancer, cardiac illness, even endometriosis –– earlier surgical intervention can prevent those symptoms from shortening your life.

How to decide if surgery is the right answer for you, now?

We’ve already covered many of the necessary steps in previous chapters:

• Get the best quality advice from the finest medical experts first. Start with the steps in Chapter 6: Hunting The Elusive Top Specialist and Surgeon to find the right specialists and surgeons in your network.

• If surgery has been recommended, even if you trust your specialist and surgeon, check out Chapter 11: Get A Second Opinion. Get A Second Opinion. Get a Second Opinion. No elective or scheduled surgery should happen without getting a second opinion first. Chapter 11 explains how to do that.

• Get educated about your diagnosis and the treatment options. The more you learn, the better. Start with Chapter 13: I Read It Online. The Good, The Bad and The Ugly of Online Medical Info. There are reliable sources of valuable information on your particular condition written for patients online. Chapter 13 steers you toward the best ones and away from the BS.

Five answers you need to have before agreeing to surgery

1. Learn about treatment options that don’t require surgery. After using the tips from Chapter 13 to learn more about the options for your diagnosis, discuss them with your chosen specialist and second opinion expert. If possible, try these treatment options first.
   
   A quick note about the difference between clinical specialists and surgeons. Clinical specialists have a toolbox of many approaches, depending on their specialty from medication to physical therapy to diet and lifestyle changes. They don’t operate.
   
   Surgeons are specialists whose toolbox is primarily surgery. They cut. Unless you’re in an emergency –– like a heart attack, septic shock, gunshot or appendicitis –– seeing a surgeon is your last step for a cure. Just don’t forget it still might be your best choice.
   
   For every orthopedic surgeon, there is an orthopedist. For every cardiac surgeon, there is a cardiologist. Same for cancer, lung disease, cervical and vaginal conditions, stomach and colon issues, etc.

   Surgery saves lives. It’s the best option when the existing alternative treatments
   have failed and your symptoms exceed the risks.

2. Talk to the surgeon, in detail, about expectations. Absolutely, definitely bring someone with you for this discussion to take notes and remind you about questions you may have missed. Ask if you can record the discussion to ensure you’ve not missed anything. The three most important groups of questions include:

   
   

   o “Why should I have surgery?”

   o “What should I expect if everything goes well?”

   o “What happens if things go wrong?”
   
   

   For specific questions, visit the official nonprofit website focused on your medical condition. Examples of valuable lists of questions include those from The Colorectal Cancer Alliance and The American Heart Association. The American College of Surgeons offers a list of ten key questions to ask before any surgery.

3. Ask about their performance metrics.

   1. “How many of these specific type of surgeries do you do each year?” Unless your surgery is for a rare medical condition, you want a big number. The more experience they have, the better your outcome. My knee replacement surgeon did hundreds of knee replacement surgeries each year.

   2. “Do you track the success rate of your surgeries six months out, one year, two years, more?” Does the surgeon have statistics for someone like you, around your age range, your gender, your specific type of surgery?

   3. “How do you track this data?” It’s okay to get into the weeds a bit about this. For example, you can ask specifically about Patient Reported Outcome Measures (PROMs) which are surveys patients fill out before and after any medical treatment. (Ideally, the surveys are co-designed by patients and not just by researchers, a personal goal of mine shared by many patient advocacy organizations).

   4. “Will I have your full attention from start to finish or will this be a concurrent or overlapping surgery?” Concurrent surgery is when the surgeon supervises key elements of two simultaneous surgeries in two different operating rooms. Overlapping is when the key elements are staggered. My personal opinion is to avoid surgeons who perform concurrent or overlapping surgeries routinely.

4. Don’t forget to discuss anesthesiology. Anesthesia is what keeps you unconscious –– or unaware –– and without pain during the procedure. The doctor in charge of this is called an anesthesiologist. The process of numbing and sedating you has risks from choosing the appropriate anesthesia before, maintaining your vital signs during the surgery and ensuring you awaken after your surgery unharmed. Top surgeons have strong working relationships with their anesthesiologists; they trust them to have their back and have developed a short-hand over the years. I’ve known surgeons who have canceled surgeries if their chosen anesthesiologist is unable to participate.

   • Who’s the anesthesiologist? There’s a shortage of board-certified anesthesiologists so alternative solutions have developed. Check if a board-certified anesthesiologist will oversee the process. Will they be with you throughout the whole surgery or do they supervise concurrent or overlapping surgeries using anesthesiology assistants of varying training?
     
     In my opinion, if they’re supervising someone else, the only appropriate replacement besides another anesthesiology doctor is a Certified Registered Nurse Anesthetist (CRNA) with a doctoral degree. However, in 23 states plus Washington, DC, anesthesiology assistants are permitted which requires only two years of training after earning a bachelor’s degree.
     
     Be aware if you live in these areas you may need to negotiate to have a CRNA or a board certified anesthesiologist for your procedure. I loudly protested when –– at the last minute –– I learned the board-certified anesthesiologist I had vetted for my son’s spinal surgery had been switched to a guy who was a used car salesman the year before. And what’s worse he introduced himself as my son’s anesthesiologist.

   • Which anesthesia will be used? All anesthesia has risks. And, the older you are, the higher the risk of cognitive decline after general anesthesia is used. Brain volume begins to decline after 50, the blood-brain barrier thins, and nerve tissue generation slows. Approximately 40 to 65% of seniors experience a decline in mental function immediately after surgery when general anesthesia is used. That covers everything from brain fog to delirium to severe memory loss and dementia. Most recover but for 10% of seniors that damage persists. If you already have a neurodegenerative disease like Parkinson’s, Alzheimer’s, MS or ALS, the risks of general anesthesia are higher. There are many alternatives to general anesthesia. Make sure to ask about those options.

5. Check out the hospital. Does it have a good track record for your type of surgery? What about their record with hospital-acquired infections, surgical errors, patient outcomes overall, and more. I highly recommend the free hospital rating resource from the nonprofit organization The Leapfrog Group.
   
   One thing you’ll learn from Leapfrog, in addition to each facility’s grade, is if they’re a fully-staffed hospital or a surgical center. My husband’s recent shoulder surgery was done at a surgical center that focused only on ambulatory (meaning no overnight stays) orthopedic surgeries. No other type of procedure or care was offered there. Every staff member was experienced with their role in orthopedic surgeries.
   
   But my husband is a healthy, athletic man who was injured rock climbing. If he had a heart attack during the procedure, the surgical center would have called 911 –– ideally while using their defibrillator –– because they don’t have a cardiologist on staff.
   
   A surgical center may not be the best choice if you are not generally healthy or have the potential for serious issues with your heart, lungs, brain or other organs. You may prefer to have your surgery done at a Level 1 trauma center with experts who can step in if any complications arise. In Chapter 6, I wrote about choosing a specialist with major medical center training. The same resources work for learning more about where your surgery will take place.

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You may not be able to complete all of these steps. The more you do, the lower your risks. Ultimately, you want to have the right type of operation when it’s necessary with the best surgical team in the safest location.

A special thanks goes to Barb Jones, MLS and Michael Millenson, President of Health Quality Advisors for their assistance in writing and researching this chapter.

Next up: Chapter 15: Rare Diseases Are Common. Why Are They Missed?

© Helene M. Epstein 2025