Unnecessary surgery: a major issue in our healthcare system

U.S. spending on healthcare has steadily increased over the last five decades. That puts a lot of strain on patients—even those who have insurance. Employer-sponsored health insurance premiums have risen faster than inflation and wages, and 73% of adults say they’re either “very” or “somewhat worried” about their ability to afford healthcare services for themselves or their families.

But patients aren’t the only ones struggling to keep up with these skyrocketing costs. Employers are also grappling with soaring spending—their healthcare costs are expected to grow between 8% to 9% in 2025.

Understandably, both patients and employers want to manage costs, but neither wants limited or lower-quality care. So, what can be done?

When up to 30% of healthcare spending could be considered waste, being more discerning about medical care is a solid first step—and that starts with reducing unnecessary surgeries and procedures.

Unnecessary surgery statistics

Unnecessary surgery might sound like more of the exception than the rule—like an occasional blunder worthy of headlines. In reality, needless procedures are surprisingly common. In one survey, physicians reported that 11.1% of procedures—one out of every ten—were unnecessary. Considering the millions of procedures performed in the U.S. each year, that’s a lot of waste.

Superfluous surgeries are particularly common in the following areas:

• Knee replacement: An alarming one out of three knee replacements in the U.S. is unnecessary.
• Spine or back surgery: In a study of 544 patients, 60% of patients were recommended for unnecessary spine surgery. And, over three years, U.S. hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries.
• Coronary stents: Between 2019 and 2021, U.S. hospitals performed over 229,000 unnecessary coronary stents. That means that, of the one million stents placed by hospitals, 22% satisfied the criteria for overuse.

Anybody can end up pursuing needless medical procedures, but they’re particularly common among older adults. More than 100,000 older Americans underwent an unnecessary surgery between March and December 2020, when simply being in the hospital during the height of the pandemic posed a risk to their health.

Health dangers aside, these unneeded or avoidable procedures also come at a hefty cost. The average knee replacement surgery, for example, costs $20,000 (and that’s on the low end). 790,000 of them are performed in the U.S. each year, but a third are unnecessary. Some rough math means that’s more than $5 billion spent on needless knee surgeries alone each year.

The causes of unnecessary surgery

The statistics are unnerving and they inevitably lead to the next question: Why are so many unnecessary procedures performed? There are a variety of factors at play, including:

• Misdiagnosis: Patients place a lot of trust in physicians, but no provider is perfect. Misdiagnosis of medical conditions can lead to futile operations. It’s also the leading cause of medicolegal claims.
• Financial incentives: The fee-for-service model that’s common in healthcare emphasizes quantity rather than quality. Patients or health insurance companies are billed for each service provided. So, more surgeries mean more money for the hospitals and providers.
• Patient demand: While much of the blame for unneeded surgeries rests with the system itself, patients aren’t entirely faultless. Some patients request or even demand unnecessary treatments from their providers. In one study, 47% of physicians said patients request an unnecessary test or procedure at least once per week.
• Failure to consider alternative treatments: The U.S. medical system often defaults to more aggressive care, which can mean skipping alternative treatments (like medications or physical therapy) that could be equally helpful. According to one study focused on a specific type of lower back pain, physical therapy proved to be just as effective as surgery—without all of the related risks.

5 dangers of unnecessary surgery

Intuitively, it makes sense that superfluous surgery will be more of a burden than a benefit for patients. But, let’s take a closer look at the different ways it can negatively impact a person’s life.

1. Physical pain and risks

Surgery is hard on the body. Recovery time can range from a few days or weeks for minor surgeries to several months or even a full year for more complex procedures.

Plus, surgery is also inherently risky. While surgical mortality in the U.S. is still relatively low (with only 0.93% of surgeries ending in death in one study), it’s a risk that’s top of mind for people who choose to pursue an operation.

And, unfortunately, the risk isn’t always a worthy tradeoff. Take knee surgeries as just one example. According to one study, one in five people reported being dissatisfied with their knee surgery.

2. Financial struggles

Cost is another major drawback of unnecessary surgery. Procedures are pricey, ranging from several thousand to tens of thousands of dollars. And, when the average per-day hospital cost in the U.S. is $2,883, adding in prep or recovery care makes surgery an expensive option.

So, it comes as little surprise that it can be a source of financial hardship. 58.5% of people who have filed for bankruptcy “very much” or “somewhat” agree that medical expenses contributed to their bankruptcy.

Additionally, surgery also often means missing out on work time. When the Family and Medical Leave Act (FMLA) only offers unpaid leave, time off for medical procedures translates to lost wages for many people.

3. Caregiving responsibilities

Surgery is disruptive—not just for the person having the operation but also for the people who care for them. Patients often need someone to transport them to and from the procedure, as well as to help them with their recovery care.

If patients are caregivers themselves—like providing for young children or aging parents—the needless surgery becomes an even bigger disturbance in their lives and to their own caregiving responsibilities.

4. Emotional and psychological pain

It’s nerve-racking to go under the knife, and research shows that unease and anxiety don’t dissipate as soon as the procedure is over.

In one study, 10.9% of patients had high levels of psychological stress the day before surgery. But, surprisingly, 13.9% had it three months after surgery. It proves that while patients “become less anxious after surgery, other forms of emotional distress increase, perhaps due to factors such as slower than anticipated recovery.”

5. Long-term health consequences

Surgery isn’t just disruptive to a person’s daily activities and responsibilities—it’s disruptive to the body. It involves cutting through tissues, which can lead to things like chronic pain, blood clots, infections, organ damage, and even disability.

Some estimates state that up to 15% of patients have serious and harmful complications following surgery. In fact, one in seven patients discharged after a major surgery is readmitted within 30 days.

This isn’t to say that surgery is inherently bad. There are plenty of times when procedures are warranted, beneficial, and even life-saving. But there are also times when they’re unnecessary and stand to do more harm than good.

Avoiding unnecessary surgery with Carrum Health

The point isn’t to avoid surgery altogether. It’s to carefully assess the risks, benefits, and costs so that patients can make decisions that prioritize quality care.

Carrum Health can help. When surgery is necessary, Carrum connects members with high-quality surgical care. Carrum partners with centers of excellence that are committed to providing only the most appropriate and necessary care.

An independent study found that 30% of members who were initially recommended surgery were later redirected to less invasive treatment options, saving both money and the risks of unnecessary surgery. Additionally, Carrum’s program reduced readmissions by 74% to 86% relative to the national average.

Carrum helps members access the relevant, quality care they deserve—without sinking time, commitment, and money into unnecessary (and ultimately unhelpful) treatments.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.