Surgical procedures need better evaluation to avoid over-treatment and wasted resources, study finds

Published Date: 30 Oct 2019

Trialling surgical procedures more widely before they are adopted would avoid over-treatment and wasted resources, research published in the British Medical Journal Open and led by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) and Universities of Bristol and Oxford has shown.

Although the UK has strict regulations to ensure new medicines work and are cost-effective before they are recommended for use in the NHS, surgical procedures are less strictly regulated. However, having unnecessary surgery exposes patients to avoidable risk of harm and wastes large amounts of money.

The study examined 10 years of hospital records across England to explore the use of subacromial decompression – a type of surgery for shoulder pain – which costs the NHS more than £125 million per year. It also compared these figures to the rates of uptake of the same procedure in other countries.

The study found that over 10 years, the numbers of subacromial decompression procedures nearly doubled in England, from 15,112 procedures in 2007/8 to 28,802 procedures in 2016/17. It also found even higher rates of these procedures being carried out in countries with less regulated health systems.

The effectiveness of subacromial decompression as a way to treat shoulder pain was questioned in 2018, when two randomised controlled trials showed the procedure to be no more effective than having no surgery at all or placebo surgery.

The study suggests that the evidence from these clinical trials should lead to a reduction in the use of subacromial decompression as a procedure to treat patients with shoulder pain. However, it recommends that better regulations and tools are needed to enhance and speed up the transfer of knowledge from trials into clinical practice, to stop the use of ineffective, avoidably harmful and wasteful surgical procedures.

Dr Tim Jones, from the University of Bristol and NIHR CLAHRC West and lead author of the study, said:

“Health systems around the world have been carrying out a lot of subacromial decompression surgery for shoulder pain over the last 25 years with little evidence that it benefits patients. This is most likely also true of other types of surgery. Given limited resources, health services should be spending their money on procedures that are backed by evidence.

It is great news that NHS England is now aiming to reduce the use of subacromial decompression. A balance needs to be struck between supporting innovation in surgical procedures and preventing unnecessary treatment. We need to develop processes that support this balance, to reduce harm to patients, and get the maximum health benefit for our money.”


Longitudinal study of use and cost of subacromial decompression surgery: the need for effective evaluation of surgical procedures to prevent overtreatment and wasted resources
Tim Jones, Andrew J Carr, David Beard, Myles-Jay Linton, Leila Rooshenas, Jenny Donovan, William Hollingworth
Published in BMJ Open