Three recently published randomized trials questioned the primacy of surgical management in 3 widely accepted operations: appendectomy for appendicitis,1 colectomy for diverticulitis,2 and knee replacement for osteoarthritis.3 What these studies had in common—setting them apart from others in the past—is that they, in randomized fashion, compared commonly used operations with significantly less aggressive or nonoperative alternatives. In all 3 trials, the less invasive treatment proved both safe and effective—not necessarily as definitive as a major operation but potentially more desirable in other important ways. All 3 of these trials challenge surgical dogma—shifting accepted treatment approaches away from long-established surgical gold-standard treatments. But when considered more broadly, these trials may begin reshaping how the medical community should think about surgical decision making.
Chhabra KR, Sacks GD, Dimick JB. Surgical Decision MakingChallenging Dogma and Incorporating Patient Preferences. JAMA. 2017;317(4):357-358. doi:10.1001/jama.2016.18719