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January 24/31, 2017

Surgical Decision Making: Challenging Dogma and Incorporating Patient Preferences

Author Affiliations
  • 1Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Surgery, University of California at Los Angeles
  • 3Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
  • 4Department of Surgery, University of Michigan, Ann Arbor
JAMA. 2017;317(4):357-358. doi:10.1001/jama.2016.18719

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.