外科手术在发达医疗体系中消耗了巨额资源：十分之六的英国人在一生中会接受手术，而在美国，每年的手术费用约为5000亿美元，占成人医疗总支出的三分之一。尽管许多手术能挽救生命，但每年仍有数以百万计的手术并无必要，甚至因并发症风险而适得其反。在占英美两国手术总量四分之一的骨科领域，十种常见手术中仅有腕管综合征松解术以及髋关节和膝关节置换术这三种的效果明确优于非手术治疗；包括腰椎减压在内的其余六种手术并不优于物理治疗或药物。类似地，约三分之二切除的阑尾本可通过抗生素治愈，而欧洲每年开展的约10万例前列腺手术中，许多病例采取观察等待效果更佳。

无效手术不仅给患者带来肉体痛苦和经济重负，更对面临人口老龄化的医疗系统造成严重浪费。仅在英格兰，减少不必要的肩部手术转诊每年就为英国国家医疗服务体系（NHS）节省约1亿英镑（约合1.34亿美元），占其手术总预算的1%。这类无效手术之所以长期存在，主要由于缺乏临床试验数据支持；与制药企业耗巨资开展随机对照试验以满足监管批准不同，外科手术没有强制性的实证监管要求，外科医生在师徒传承中往往将术后康复默认归功于手术本身，缺乏主动开展疗效验证的动力与手段。

纠正这一制度性缺陷需要政府主导开展覆盖多中心医院的随机临床试验，从而使公共医保与商业保险机构能够有据可依地对无效手术拒绝报销。剔除无效的背部和肩部手术，将使外科医生能够集中精力开展髋膝关节置换等真正有效的手术，从而大幅缩短排队名单——例如7月份英格兰等待非紧急专科治疗的患者高达620万人。此外，医学教育和规培体系必须改变“唯手术刀”的传统思维，将医患共同决策制度化，促使医生与患者共同权衡非手术方案而非单向强制施治。

Surgical interventions consume immense resources in advanced healthcare economies, with six in ten Britons undergoing surgery and American procedures costing approximately $500bn annually, representing one-third of adult medical spending. Despite critical life-saving operations, millions of procedures are clinically unnecessary and expose patients to surgical complications. In orthopaedics, which comprises 25% of operations in Britain and the United States, an assessment of ten common procedures revealed that only three—carpal tunnel release along with hip and knee replacements—demonstrate outcomes superior to non-operative treatment. Six interventions, including lumbar-spine decompression, offer no benefits over physiotherapy or medication. Similarly, two-thirds of appendectomies could be resolved with antibiotics, while watchful waiting is superior for many of the roughly 100,000 prostate operations performed annually in Europe.

These non-beneficial procedures inflict avoidable physical trauma, financial stress, and systemic fiscal waste across aging nations. In England, reducing referrals for unnecessary shoulder operations alone generates recurring savings for the National Health Service of approximately £100m ($134m) annually, equivalent to 1% of its overall surgical budget. The perpetuation of ineffective surgeries stems primarily from an acute deficit of rigorous clinical trial data. Unlike pharmaceutical manufacturers, which finance expansive randomized controlled trials to satisfy regulatory approval standards, surgeons operate under an apprenticeship model where post-operative recovery is uncritically attributed to intervention efficacy without regulatory mandates for empirical validation or individual financial incentives for rigorous verification.

Rectifying this systemic failure requires state-funded randomized trials across diverse hospital networks to generate objective efficacy benchmarks, enabling public healthcare systems and private insurers to restrict reimbursement for debunked procedures. Discontinuing ineffective back and shoulder operations would redirect surgical capacity toward genuinely beneficial hip, knee, and carpal tunnel interventions, directly addressing treatment backlogs such as the 6.2m English patients awaiting elective specialist care in July. Furthermore, reforming medical education and surgical training to embed shared decision-making will ensure practitioners present comprehensive therapeutic alternatives rather than reflexively defaulting to operative intervention.

Source: Back and shoulder surgery is often worse than useless

Subtitle: Millions of operations should be scrapped

Dateline: Sep 24th 2026\n