Surgery is often `futile and rash'

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OVER-ADVENTUROUS surgeons are operating on patients where treatment is futile, a report said yesterday.

Advances in surgery and anaesthesia have led doctors and patients to think that every medical problem can be solved. But in many cases the treatment might be worse than the disease, said The National Confidential Enquiry into Perioperative Deaths [deaths after surgery]

National Cepod, an independent body set up with government funding to monitor surgery, said that surgeons and anaesthetists must keep up with technological innovations and new skills, but must also recognise when it is best to let patients be.

However, it also warned that pressure on beds was putting patients at risk as faster treatment increased stress and the likelihood of side-effects.

Ron Hoile, the principal co-ordinator of the study, said: "It is a surgical skill to recognise when surgery will be too adventurous, ill-advised or futile, given the condition of the patient. It is difficult to resist pressure to operate, whether this comes from the patient, relatives or medical colleagues but it must be recognised that surgery cannot solve every problem."

There are about 20,000 deaths after surgery every year, and more than three million operations per year that patients survive. The study, conducted every two years, examined a sample of 2,500 operations to see what lessons could be learnt.

In addition to advising surgeons, the report said patients and relatives must also recognise the limits of what could be done, especially in cases of advanced cancer. Surgeons sometimes came under pressure and chose to operate because they feared being criticised for not doing so.

The report also warned that keyhole surgery was not the minor procedure that it was widely perceived to be. It had resulted in deaths. Anthony Grey, a consultant anaesthetist and a member of the study team, said an operation on the abdomen imposed the same physiological stress whether there were three or four small incisions (as for a keyhole procedure) or one large one.

The Government drive to increase the number of patients treated and reduce waiting lists was also raising risks, the report added.

But a spokeswoman for Macmillan Cancer Relief, which helps 200,000 cancer sufferers, said: "This decision isn't black or white, but we do think that anything that improves the quality of the patient's life, for however short a time, should be undertaken."

Two of the most common gynaecological problems, infertility and heavy periods, are poorly treated because GPs and specialists offer outdated tests and drugs, according to the Royal College of Obstetricians and Gynaecologists.

One in five women has a hysterectomy, usually for menstrual problems, but in many cases the womb turns out to be normal, said the college, which issued new guidelines on treatment to its members yesterday.