Perspectives on surgical indications. Implications for controls.

Abstract

Surgical indications do not forecast outcomes as well as they should. A review of the literature demonstrates a significant rate of overutilization of coronary angiography, coronary artery surgery, cardiac pacemaker insertion, upper gastrointestinal endoscopies, carotid endarterectomies, back surgery, and pain-relieving procedures. The tendency appears to be a reduction in developing specific indications, and the evolution of a "last resort" concept. Arguments against this approach and a plea for the development of tighter focused indications are presented. Implications for cost saving and reduction in suffering are discussed.